Pub Date : 2024-12-18DOI: 10.1016/j.ssmhs.2024.100046
Dhiman Debsarma , Bikramaditya Kumar Choudhary
Rural Unqualified Health Practitioners (RUHPs) are popular among the rural population for primary healthcare in India. The RUHPs primarily provide basic healthcare for minor illnesses to millions of people. Patients/people in the rural areas often seek healthcare from RUHPs due to multiple social, economic, and cultural factors. Therefore, using the “social-ecological model (SEM)” as the theoretical base, this study attempts to explore the significant factors that influence health-seeking behaviour, with medical shops of RUHPs being the preferred option, in West Bengal state in India. Using SEM, we developed a comparative analysis between user experiences and provider perceptions. We conducted a primary survey using the pre-prepared semi-structured and unstructured open-ended guide. The household heads (n = 150), RUHPs (n = 75), Primary Health Centres (PHCs), and Sub-Centre staff (n = 30) were the participants in this survey. Transcripts were coded using the thematic content analysis method. Based on SEM, we grouped socio-ecological factors of seeking care into four significant levels: Individual (people’s traditional beliefs, poor health education, gender, and predisposed experiences), Interpersonal (strong social cohesion, tight social bondage, trust and networks, and social support), Community (neighborhood effect, primary resource based activities and livelihood, economic hardship, and density of the medical shop) and Institutional (uneven facility distribution, odd location, resource-related issues, limited and poor quality of services, and gender of staff at Sub-centres). Therefore, the study highlighted that multiple social-ecological factors are responsible for pushing people to RUHP for healthcare in rural areas in West Bengal.
{"title":"Exploring the socio-ecological factors of healthcare-seeking behaviour among patients/people from Rural Unqualified Health Providers in the rural settings in West Bengal, India","authors":"Dhiman Debsarma , Bikramaditya Kumar Choudhary","doi":"10.1016/j.ssmhs.2024.100046","DOIUrl":"10.1016/j.ssmhs.2024.100046","url":null,"abstract":"<div><div>Rural Unqualified Health Practitioners (RUHPs) are popular among the rural population for primary healthcare in India. The RUHPs primarily provide basic healthcare for minor illnesses to millions of people. Patients/people in the rural areas often seek healthcare from RUHPs due to multiple social, economic, and cultural factors. Therefore, using the “social-ecological model (SEM)” as the theoretical base, this study attempts to explore the significant factors that influence health-seeking behaviour, with medical shops of RUHPs being the preferred option, in West Bengal state in India. Using SEM, we developed a comparative analysis between user experiences and provider perceptions. We conducted a primary survey using the pre-prepared semi-structured and unstructured open-ended guide. The household heads (n = 150), RUHPs (n = 75), Primary Health Centres (PHCs), and Sub-Centre staff (n = 30) were the participants in this survey. Transcripts were coded using the thematic content analysis method. Based on SEM, we grouped socio-ecological factors of seeking care into four significant levels: Individual (people’s traditional beliefs, poor health education, gender, and predisposed experiences), Interpersonal (strong social cohesion, tight social bondage, trust and networks, and social support), Community (neighborhood effect, primary resource based activities and livelihood, economic hardship, and density of the medical shop) and Institutional (uneven facility distribution, odd location, resource-related issues, limited and poor quality of services, and gender of staff at Sub-centres). Therefore, the study highlighted that multiple social-ecological factors are responsible for pushing people to RUHP for healthcare in rural areas in West Bengal.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100046"},"PeriodicalIF":0.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143175513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-14DOI: 10.1016/j.ssmhs.2024.100045
Vinicius Delgado Ramos , Sarah Polack , Veronika Reichenberger , Nathaniel Scherer , Loveday Penn-Kekana , Indyara de Araujo Morais , Hannah Kuper , Christina May Moran de Brito
Multiple health system components, supported by good policy, are needed for the provision of quality rehabilitation care. This study used the Missing Billion Health System Framework to structure a situational analysis of publicly funded rehabilitation services within the Unified Health System in Brazil, focusing on: governance, leadership, health financing, data and evidence, autonomy and awareness, affordability, human resources, health facilities, and assistive technology. We reviewed online policy documents, Health Information System data and published literature and conducted semi-structured interviews with 87 people with disabilities and 57 health and rehabilitation providers in São Paulo, Santos, Brasília, and Arcoverde. The situational analysis showed that the Brazilian policy framework is broadly supportive of rehabilitation provision, and a defined leadership structure assists rehabilitation provision at the national, state, and municipality level. However, there are challenges to rehabilitation service provision including insufficient funding and service availability, and inadequate numbers of rehabilitation professionals, with variation by cadre and region. For service users with disabilities, key challenges to accessing rehabilitation include high costs of transport, communication and information barriers, and long wait times. Available data indicate high-need and low coverage for rehabilitation, although there is a gap in reliable data on service need. In conclusion, this situational analysis highlighted rehabilitation programme and policy strengths in Brazil that could be replicated in other settings, such as the supportive policy and leadership structure. However, there are gaps to be addressed, including geographic inequalities in the availability of rehabilitation professionals and barriers to access for service users.
{"title":"A situational analysis of rehabilitation policy and systems in Brazil","authors":"Vinicius Delgado Ramos , Sarah Polack , Veronika Reichenberger , Nathaniel Scherer , Loveday Penn-Kekana , Indyara de Araujo Morais , Hannah Kuper , Christina May Moran de Brito","doi":"10.1016/j.ssmhs.2024.100045","DOIUrl":"10.1016/j.ssmhs.2024.100045","url":null,"abstract":"<div><div>Multiple health system components, supported by good policy, are needed for the provision of quality rehabilitation care. This study used the Missing Billion Health System Framework to structure a situational analysis of publicly funded rehabilitation services within the Unified Health System in Brazil, focusing on: governance, leadership, health financing, data and evidence, autonomy and awareness, affordability, human resources, health facilities, and assistive technology. We reviewed online policy documents, Health Information System data and published literature and conducted semi-structured interviews with 87 people with disabilities and 57 health and rehabilitation providers in São Paulo, Santos, Brasília, and Arcoverde. The situational analysis showed that the Brazilian policy framework is broadly supportive of rehabilitation provision, and a defined leadership structure assists rehabilitation provision at the national, state, and municipality level. However, there are challenges to rehabilitation service provision including insufficient funding and service availability, and inadequate numbers of rehabilitation professionals, with variation by cadre and region. For service users with disabilities, key challenges to accessing rehabilitation include high costs of transport, communication and information barriers, and long wait times. Available data indicate high-need and low coverage for rehabilitation, although there is a gap in reliable data on service need. In conclusion, this situational analysis highlighted rehabilitation programme and policy strengths in Brazil that could be replicated in other settings, such as the supportive policy and leadership structure. However, there are gaps to be addressed, including geographic inequalities in the availability of rehabilitation professionals and barriers to access for service users.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100045"},"PeriodicalIF":0.0,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143176586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-14DOI: 10.1016/j.ssmhs.2024.100047
Doreen Mucheru , Jacqueline Harley , Elizabeth Lulu Genda , Brynne Gilmore , Anosisye M. Kesale , Eilish McAuliffe , Agnes Mpinga , Cinty Narcis , Henry Mollel
Over the past two decades, women’s participation in the workforce has increased, but their representation in senior roles remains suboptimal. In Tanzania, women comprise 70 % of the health workforce, but occupy only 17.4 % of senior and middle-management positions. This disparity highlights the presence of barriers to women's leadership advancement. To better understand gender in healthcare leadership, this study conducted a national cross-sectional survey with healthcare leaders between June and September 2023 to assess contemporary gender stereotypes and their characterisation among Tanzanian healthcare leaders. Men comprised more than half (59 %) of the sample (N = 200). While 62.5 % of participants indicated no preference for the gender of their leader, 22 % preferred a man. Mean overall agency ratings were higher for men compared to women, whereas mean communality ratings were higher for women. Analysis of communality scores revealed a significant difference (U = 3110, p = 0.032), with men rating their own gender higher compared to the ratings given by women. Assessments of agency indicated that women rated women higher than men did, with differences approaching statistical significance (U= 3530 p = 0.059). These patterns indicate the presence of gender-based stereotyping. Each gender also viewed themselves more positively, as demonstrated by higher ratings of their own gender compared to ratings of the opposite gender. These findings may have adverse implications for women's representation in Tanzania's healthcare leadership landscape. Findings highlight the significant potential gender sensitivity and equality initiatives have in the Tanzanian context, as they could help mitigate stereotypes and their deleterious effects on women's leadership.
{"title":"The gender stereotype landscape in Tanzania: A national study with healthcare leaders","authors":"Doreen Mucheru , Jacqueline Harley , Elizabeth Lulu Genda , Brynne Gilmore , Anosisye M. Kesale , Eilish McAuliffe , Agnes Mpinga , Cinty Narcis , Henry Mollel","doi":"10.1016/j.ssmhs.2024.100047","DOIUrl":"10.1016/j.ssmhs.2024.100047","url":null,"abstract":"<div><div>Over the past two decades, women’s participation in the workforce has increased, but their representation in senior roles remains suboptimal. In Tanzania, women comprise 70 % of the health workforce, but occupy only 17.4 % of senior and middle-management positions. This disparity highlights the presence of barriers to women's leadership advancement. To better understand gender in healthcare leadership, this study conducted a national cross-sectional survey with healthcare leaders between June and September 2023 to assess contemporary gender stereotypes and their characterisation among Tanzanian healthcare leaders. Men comprised more than half (59 %) of the sample (N = 200). While 62.5 % of participants indicated no preference for the gender of their leader, 22 % preferred a man. Mean overall agency ratings were higher for men compared to women, whereas mean communality ratings were higher for women. Analysis of communality scores revealed a significant difference (U = 3110, p = 0.032), with men rating their own gender higher compared to the ratings given by women. Assessments of agency indicated that women rated women higher than men did, with differences approaching statistical significance (U= 3530 p = 0.059). These patterns indicate the presence of gender-based stereotyping. Each gender also viewed themselves more positively, as demonstrated by higher ratings of their own gender compared to ratings of the opposite gender. These findings may have adverse implications for women's representation in Tanzania's healthcare leadership landscape. Findings highlight the significant potential gender sensitivity and equality initiatives have in the Tanzanian context, as they could help mitigate stereotypes and their deleterious effects on women's leadership.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100047"},"PeriodicalIF":0.0,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143176531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-05DOI: 10.1016/j.ssmhs.2024.100043
Mingqi Song , Lutfan Lazuardi , Raymond Francis R. Sarmiento , Brian Sahar Afifah , Gabi Ceria , Razel G. Custodio , Zahrotul Kamilah , Romeo Luis A. Macabasag , Tiara Marthias , Monica B. Sunga , Karen A. Grépin
The COVID-19 pandemic highlighted the importance of high-quality, geographically disaggregated, and high-frequency data for real-time evidence-based decision-making in health systems. Routine health information systems (RHIS) collect and aggregate such data but to date there have been few case studies of how RHIS were used to support COVID-19 responses in low and middle-income countries. From July-October 2021, we conducted 112 in-depth key informant interviews (KII) and seven focus group discussions (FGDs) with policymakers in Indonesia and the Philippines to better understand the role of RHIS in supporting national responses to COVID-19. Data were analysed thematically to answer key research questions: (1) How did the pandemic affect RHIS data processes? (2) How were COVID-specific data collected and integrated into RHIS? (3) How were RHIS data used to inform response measures? (4) How did RHIS interact with other health system building blocks? We found that pandemic disrupted RHIS processes, leading to a decline in the quantity, quality, and availability of RHIS data. But the pandemic also increased awareness and appreciation of RHISs, creating opportunities to strengthen and improve the utilization of the system. RHIS data and processes were directly leveraged in critical ways to strengthen the COVID-19 response, such as contact tracing and vaccination. It also indirectly supported responses via other health system building blocks, for example, by providing important data to support the design of a COVID-19 benefit package design. However, the study also identified pre-existing challenges that limited the ability of health system planners and policymakers to optimally leverage RHIS data during the pandemic. Strengthening RHIS should be integrated into future pandemic planning activities as RHIS data and processes played critical roles during the pandemic in both countries.
{"title":"The role of routine health information systems in supporting the COVID-19 pandemic response in the Philippines and Indonesia","authors":"Mingqi Song , Lutfan Lazuardi , Raymond Francis R. Sarmiento , Brian Sahar Afifah , Gabi Ceria , Razel G. Custodio , Zahrotul Kamilah , Romeo Luis A. Macabasag , Tiara Marthias , Monica B. Sunga , Karen A. Grépin","doi":"10.1016/j.ssmhs.2024.100043","DOIUrl":"10.1016/j.ssmhs.2024.100043","url":null,"abstract":"<div><div>The COVID-19 pandemic highlighted the importance of high-quality, geographically disaggregated, and high-frequency data for real-time evidence-based decision-making in health systems. Routine health information systems (RHIS) collect and aggregate such data but to date there have been few case studies of how RHIS were used to support COVID-19 responses in low and middle-income countries. From July-October 2021, we conducted 112 in-depth key informant interviews (KII) and seven focus group discussions (FGDs) with policymakers in Indonesia and the Philippines to better understand the role of RHIS in supporting national responses to COVID-19. Data were analysed thematically to answer key research questions: (1) How did the pandemic affect RHIS data processes? (2) How were COVID-specific data collected and integrated into RHIS? (3) How were RHIS data used to inform response measures? (4) How did RHIS interact with other health system building blocks? We found that pandemic disrupted RHIS processes, leading to a decline in the quantity, quality, and availability of RHIS data. But the pandemic also increased awareness and appreciation of RHISs, creating opportunities to strengthen and improve the utilization of the system. RHIS data and processes were directly leveraged in critical ways to strengthen the COVID-19 response, such as contact tracing and vaccination. It also indirectly supported responses via other health system building blocks, for example, by providing important data to support the design of a COVID-19 benefit package design. However, the study also identified pre-existing challenges that limited the ability of health system planners and policymakers to optimally leverage RHIS data during the pandemic. Strengthening RHIS should be integrated into future pandemic planning activities as RHIS data and processes played critical roles during the pandemic in both countries.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100043"},"PeriodicalIF":0.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143175514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-04DOI: 10.1016/j.ssmhs.2024.100042
Loraine J. Bacchus , Stephanie Pereira , Nagham Joudeh , Beatriz Diniz Kalichman , Samita K.C. , Prabhash Siriwardhana , Tharuka Silva , Ana Flavia Pires Lucas d’Oliveira , Poonam Rishal , Satya Shrestha , Lilia Blima Schraiber , Abdulsalam Alkaiyat , Thilini Rajapakse , Amira Shaheen , Gene Feder , Helen Lambert , Claudia Garcia Moreno , Manuela Colombini , the HERA research team
Background
Domestic violence (DV) against women has adverse health consequences and demands a comprehensive healthcare response. Interventions adapted from high-income countries encounter implementation challenges in low-and-middle-income countries, due to diverse socio-cultural, political and economic contexts. This study explored HERA (Healthcare Responding to Violence and Abuse) implementation, that aimed to strengthen the healthcare response to DV in Brazil, Nepal, the occupied Palestinian territory (oPt), and Sri Lanka.
Methods
Parallel mixed method study (2019 – 2022). Quantitative data included the Provider Intervention Measure (PIM), training attendance records and DV documentation before and after the intervention. Qualitative data included semi-structured interviews with providers and DV survivors, field notes and stakeholder meetings. Data were integrated at the level of interpretation and reporting using a narrative approach, drawing on theories of Complex Adaptive Systems and sensemaking.
Results
HERA enhanced healthcare provider readiness to address DV and fostered a women-centred approach. The interaction between HERA and the diverse contexts impacted the reciprocal relationship between sensemaking and sensegiving within health systems, leading to adaptive behaviours among providers and women. This included mediation practices, negotiating DV documentation, modified roles, and containment of DV cases within the clinic. Normative gender roles, normalised DV attitudes, biomedical sensemaking frameworks, community violence, austerity policies, scarce resources, and weak leadership and management support affected implementation success.
Conclusion
It is important to consider the interplay between context and intervention goals during development, implementation and evaluation of health system responses to DV. Managers require specific intervention components to support organisational change. Culturally appropriate support for women should acknowledge limitations to their agency.
{"title":"A multi-country mixed method evaluation of the HERA (Healthcare Responding to Domestic Violence and Abuse) intervention: A comparative analysis","authors":"Loraine J. Bacchus , Stephanie Pereira , Nagham Joudeh , Beatriz Diniz Kalichman , Samita K.C. , Prabhash Siriwardhana , Tharuka Silva , Ana Flavia Pires Lucas d’Oliveira , Poonam Rishal , Satya Shrestha , Lilia Blima Schraiber , Abdulsalam Alkaiyat , Thilini Rajapakse , Amira Shaheen , Gene Feder , Helen Lambert , Claudia Garcia Moreno , Manuela Colombini , the HERA research team","doi":"10.1016/j.ssmhs.2024.100042","DOIUrl":"10.1016/j.ssmhs.2024.100042","url":null,"abstract":"<div><h3>Background</h3><div>Domestic violence (DV) against women has adverse health consequences and demands a comprehensive healthcare response. Interventions adapted from high-income countries encounter implementation challenges in low-and-middle-income countries, due to diverse socio-cultural, political and economic contexts. This study explored HERA (Healthcare Responding to Violence and Abuse) implementation, that aimed to strengthen the healthcare response to DV in Brazil, Nepal, the occupied Palestinian territory (oPt), and Sri Lanka.</div></div><div><h3>Methods</h3><div>Parallel mixed method study (2019 – 2022). Quantitative data included the Provider Intervention Measure (PIM), training attendance records and DV documentation before and after the intervention. Qualitative data included semi-structured interviews with providers and DV survivors, field notes and stakeholder meetings. Data were integrated at the level of interpretation and reporting using a narrative approach, drawing on theories of Complex Adaptive Systems and sensemaking.</div></div><div><h3>Results</h3><div>HERA enhanced healthcare provider readiness to address DV and fostered a women-centred approach. The interaction between HERA and the diverse contexts impacted the reciprocal relationship between sensemaking and sensegiving within health systems, leading to adaptive behaviours among providers and women. This included mediation practices, negotiating DV documentation, modified roles, and containment of DV cases within the clinic. Normative gender roles, normalised DV attitudes, biomedical sensemaking frameworks, community violence, austerity policies, scarce resources, and weak leadership and management support affected implementation success.</div></div><div><h3>Conclusion</h3><div>It is important to consider the interplay between context and intervention goals during development, implementation and evaluation of health system responses to DV. Managers require specific intervention components to support organisational change. Culturally appropriate support for women should acknowledge limitations to their agency.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100042"},"PeriodicalIF":0.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143175515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-22DOI: 10.1016/j.ssmhs.2024.100041
Mohamed Ali Ag Ahmed , Mahmoud Cissé , Hassane Alami , Bart Criel
Background
Front-line health services (FHSs) are the gateway to health systems. FHSs in Africa have been hit hard by the COVID-19 pandemic. In Mali, FHSs are provided by community health centres (Centres de Santé Communautaires (CSComs)). The objective of this study, which, to our knowledge, is the first of its kind in Mali, was to assess the impact of the COVID-19 pandemic on the functioning of CSComs within a health district.
Method
This qualitative case study was carried out in four CSComs in the Kati Health District in Mali. A three-dimensional analytical framework was designed and used. Data was collected from 24 key informants through semi-structured interviews. Thematic content analysis was performed, and Nvivo software was used.
Results
Data analysis showed that the COVID-19 pandemic impacted all dimensions of our analytical framework. Within the CSComs, the following were particularly impacted: 1) the management of activities with adaptations in the management of human and financial resources, infrastructure and equipment, the supply of inputs and medicines and the national health information system/surveillance; 2) the provision of curative, preventive and promotional health services; and 3) the interactions among stakeholders with little coordination of their actions.
Conclusion
This study offers insights into how to improve FHSs' resilience to crises. The results indicated dysfunction in routine health services, a decline in patients' use of them, and inadequate coordination among stakeholders. Despite their low level of preparedness, the CSComs were able to ensure continuity of care.
一线卫生服务是通往卫生系统的门户。非洲的fhs受到COVID-19大流行的严重打击。在马里，家庭保健服务由社区保健中心（centres de sant communautaire）提供。据我们所知，本研究是马里首个此类研究，其目的是评估COVID-19大流行对卫生区内社区服务委员会运作的影响。方法对马里卡蒂卫生区的4家社区医院进行定性个案研究。设计并使用了三维分析框架。通过半结构化访谈收集了24名关键线人的数据。采用Nvivo软件进行主题内容分析。结果数据分析显示，COVID-19大流行影响了我们分析框架的所有维度。在cscom内，下列方面受到特别影响：1)管理人力和财政资源、基础设施和设备、投入物和药品供应以及国家卫生信息系统/监测方面的活动；2)提供治疗、预防和促进保健服务；3)利益相关者之间的相互作用，他们的行动很少协调。结论本研究为提高金融服务机构的危机应变能力提供了新的思路。结果表明，常规卫生服务功能失调，患者使用这些服务的人数下降，利益相关者之间的协调不足。尽管ccoms的准备水平较低，但它们能够确保护理的连续性。
{"title":"Impact of the COVID-19 pandemic on the functioning of front-line health services in the Kati health district in Mali, West Africa: A qualitative study","authors":"Mohamed Ali Ag Ahmed , Mahmoud Cissé , Hassane Alami , Bart Criel","doi":"10.1016/j.ssmhs.2024.100041","DOIUrl":"10.1016/j.ssmhs.2024.100041","url":null,"abstract":"<div><h3>Background</h3><div>Front-line health services (FHSs) are the gateway to health systems. FHSs in Africa have been hit hard by the COVID-19 pandemic. In Mali, FHSs are provided by community health centres (<em>Centres de Santé Communautaires</em> (CSComs)). The objective of this study, which, to our knowledge, is the first of its kind in Mali, was to assess the impact of the COVID-19 pandemic on the functioning of CSComs within a health district.</div></div><div><h3>Method</h3><div>This qualitative case study was carried out in four CSComs in the Kati Health District in Mali. A three-dimensional analytical framework was designed and used. Data was collected from 24 key informants through semi-structured interviews. Thematic content analysis was performed, and Nvivo software was used.</div></div><div><h3>Results</h3><div>Data analysis showed that the COVID-19 pandemic impacted all dimensions of our analytical framework. Within the CSComs, the following were particularly impacted: 1) the management of activities with adaptations in the management of human and financial resources, infrastructure and equipment, the supply of inputs and medicines and the national health information system/surveillance; 2) the provision of curative, preventive and promotional health services; and 3) the interactions among stakeholders with little coordination of their actions.</div></div><div><h3>Conclusion</h3><div>This study offers insights into how to improve FHSs' resilience to crises. The results indicated dysfunction in routine health services, a decline in patients' use of them, and inadequate coordination among stakeholders. Despite their low level of preparedness, the CSComs were able to ensure continuity of care.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100041"},"PeriodicalIF":0.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-08DOI: 10.1016/j.ssmhs.2024.100040
Rachel Cassidy , Agnes Rwashana Semwanga , Peter Binyaruka , Karl Blanchet , Neha S. Singh , John Maiba , Josephine Borghi
Payment for performance (P4P) is not a uniform intervention, with programme effect dependent on several interconnected factors. In this study, a system dynamics model was developed to explore the pathways to improved outcomes and how changes in the design, implementation and context of a P4P programme affected maternal and child health (MCH) service delivery outcomes in Tanzania. A previously developed causal loop diagram of the programme effects was used to inform model development, with further data sources (including an impact evaluation of programme, health surveys, stakeholder feedback and relevant literature) used to build the model. A number of pathways were identified to improved services under P4P, with increased availability of drugs underpinning the content of care outcome (intermittent preventative treatment during ANC), which together with increased supervision, enhanced health worker motivation. This in turn increased perceived quality of care at the facility which improved the coverage of services outcome (facility-based deliveries), and with increased outreach, increased awareness of services also boosted demand. Minor delays in payment reduced provider purchasing power for medicines, with severe delays driving erosion of provider trust and motivation for programme participation. Allocating a larger share of funds for facility operations can enhance performance effects, particularly for those services that rely on efficient drug administration. Contextual factors including limited baseline provision of essential medications, lower community awareness of facility services and dispersed/distant populations reduced programme effect. This paper demonstrates the feasibility and the potential of such models to inform the design of effective health system interventions.
{"title":"Identifying the active ingredients in payment for performance programmes using system dynamics modelling","authors":"Rachel Cassidy , Agnes Rwashana Semwanga , Peter Binyaruka , Karl Blanchet , Neha S. Singh , John Maiba , Josephine Borghi","doi":"10.1016/j.ssmhs.2024.100040","DOIUrl":"10.1016/j.ssmhs.2024.100040","url":null,"abstract":"<div><div>Payment for performance (P4P) is not a uniform intervention, with programme effect dependent on several interconnected factors. In this study, a system dynamics model was developed to explore the pathways to improved outcomes and how changes in the design, implementation and context of a P4P programme affected maternal and child health (MCH) service delivery outcomes in Tanzania. A previously developed causal loop diagram of the programme effects was used to inform model development, with further data sources (including an impact evaluation of programme, health surveys, stakeholder feedback and relevant literature) used to build the model. A number of pathways were identified to improved services under P4P, with increased availability of drugs underpinning the content of care outcome (intermittent preventative treatment during ANC), which together with increased supervision, enhanced health worker motivation. This in turn increased perceived quality of care at the facility which improved the coverage of services outcome (facility-based deliveries), and with increased outreach, increased awareness of services also boosted demand. Minor delays in payment reduced provider purchasing power for medicines, with severe delays driving erosion of provider trust and motivation for programme participation. Allocating a larger share of funds for facility operations can enhance performance effects, particularly for those services that rely on efficient drug administration. Contextual factors including limited baseline provision of essential medications, lower community awareness of facility services and dispersed/distant populations reduced programme effect. This paper demonstrates the feasibility and the potential of such models to inform the design of effective health system interventions.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100040"},"PeriodicalIF":0.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142743694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-25DOI: 10.1016/j.ssmhs.2024.100039
Daniel J. Kruger , Hilary M. Kirk , Kenneth E. Leonard , Joshua J. Lynch , Nancy Nielsen , Brian M. Clemency
Drug overdose is a leading cause of death in New York State, with opioid-related deaths increasing by more than 300 % from 2010 to 2020. Survey respondents (N = 392) for organizations providing a wide range of substance misuse related services rated the importance of barriers to accessing services, the helpfulness of strategies in addressing challenges, and priorities for further scientific study. Difficulties in obtaining funding were rated the highest barrier to accessing substance use services, insufficient skills in the workforce were rated as the second most important barrier, and stigma towards addiction was rated third. An analysis of wages and scale-up strategies to provide competitive workforce opportunities was rated as the most helpful strategy in addressing workforce challenges. The most helpful strategy in addressing stigma was to work in partnership with other organizations to enhance the continuum of substance misuse related services. Most of the strategies that were surveyed were rated as very helpful overall, which may not be surprising given that they were nominated by experts as very important. Customized prevention, treatment, harm reduction, and recovery services based on individual characteristics and integrating medications for opioid use disorder into other medical settings were rated as the most important strategies in prioritizing further scientific study. The pattern of ratings showed only a few differences based on organizational role and geographic region, for example respondents in New York City considered increasing the availability of telemedicine as a higher priority.
{"title":"Assessing challenges and solutions in substance abuse prevention, harm reduction, and treatment services in New York State","authors":"Daniel J. Kruger , Hilary M. Kirk , Kenneth E. Leonard , Joshua J. Lynch , Nancy Nielsen , Brian M. Clemency","doi":"10.1016/j.ssmhs.2024.100039","DOIUrl":"10.1016/j.ssmhs.2024.100039","url":null,"abstract":"<div><div>Drug overdose is a leading cause of death in New York State, with opioid-related deaths increasing by more than 300 % from 2010 to 2020. Survey respondents (<em>N</em> = 392) for organizations providing a wide range of substance misuse related services rated the importance of barriers to accessing services, the helpfulness of strategies in addressing challenges, and priorities for further scientific study. Difficulties in obtaining funding were rated the highest barrier to accessing substance use services, insufficient skills in the workforce were rated as the second most important barrier, and stigma towards addiction was rated third. An analysis of wages and scale-up strategies to provide competitive workforce opportunities was rated as the most helpful strategy in addressing workforce challenges. The most helpful strategy in addressing stigma was to work in partnership with other organizations to enhance the continuum of substance misuse related services. Most of the strategies that were surveyed were rated as very helpful overall, which may not be surprising given that they were nominated by experts as very important. Customized prevention, treatment, harm reduction, and recovery services based on individual characteristics and integrating medications for opioid use disorder into other medical settings were rated as the most important strategies in prioritizing further scientific study. The pattern of ratings showed only a few differences based on organizational role and geographic region, for example respondents in New York City considered increasing the availability of telemedicine as a higher priority.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100039"},"PeriodicalIF":0.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142560624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1016/j.ssmhs.2024.100038
Tory Crawford, Louise Chartrand, Cara Brown, Brontë Vollebregt, Patricia Thille
Introduction
The COVID-19 pandemic required substantial changes in delivery of team-based primary care, impacting both how and which patients accessed the more comprehensive services teams provide. We sought to explore changes in access to primary care rehabilitation services during the first year of the COVID-19 pandemic to identify potential new problems and improvements.
Methods
In this longitudinal study, sixteen rehabilitation professionals working on primary care teams in Manitoba and Ontario recorded audio-diaries and later participated in interviews throughout the first year of the pandemic. Qualitative analysis included data immersion, coding to identify the practice changes and associated access impacts, then applying Levesque and colleagues’ Patient-Centred Access to Healthcare framework to interpret findings.
Findings
Participants described service changes that both enhanced and reduced access, including redeployment, outreach, virtual care, discontinuation of some services and start of new ones, and new risk management strategies. Some implied equity-specific impacts. Virtual care and outreach activities created access for patient populations who previously may have been underserved, while virtual care, redeployment, and new risk management activities created new access barriers and inequities, leaving some patients completely unable to reach care. Changes to team collaboration activities could help or hinder access.
Conclusion
Continuing outreach activities, strengthening team collaboration, and thoughtfully integrating virtual care can improve access to comprehensive primary care. As the primary care sector works to recover from pandemic impacts and address population health needs, applying a patient-centred access framework during practice redesign offers a meaningful way to strengthen services.
{"title":"Evaluating access during change: A qualitative exploration of access impacts to Canadian primary care rehabilitation providers during the COVID-19 pandemic","authors":"Tory Crawford, Louise Chartrand, Cara Brown, Brontë Vollebregt, Patricia Thille","doi":"10.1016/j.ssmhs.2024.100038","DOIUrl":"10.1016/j.ssmhs.2024.100038","url":null,"abstract":"<div><h3>Introduction</h3><div>The COVID-19 pandemic required substantial changes in delivery of team-based primary care, impacting both <em>how</em> and <em>which</em> patients accessed the more comprehensive services teams provide. We sought to explore changes in access to primary care rehabilitation services during the first year of the COVID-19 pandemic to identify potential new problems and improvements.</div></div><div><h3>Methods</h3><div>In this longitudinal study, sixteen rehabilitation professionals working on primary care teams in Manitoba and Ontario recorded audio-diaries and later participated in interviews throughout the first year of the pandemic. Qualitative analysis included data immersion, coding to identify the practice changes and associated access impacts, then applying Levesque and colleagues’ Patient-Centred Access to Healthcare framework to interpret findings.</div></div><div><h3>Findings</h3><div>Participants described service changes that both enhanced and reduced access, including redeployment, outreach, virtual care, discontinuation of some services and start of new ones, and new risk management strategies. Some implied equity-specific impacts. Virtual care and outreach activities created access for patient populations who previously may have been underserved, while virtual care, redeployment, and new risk management activities created new access barriers and inequities, leaving some patients completely unable to reach care. Changes to team collaboration activities could help or hinder access.</div></div><div><h3>Conclusion</h3><div>Continuing outreach activities, strengthening team collaboration, and thoughtfully integrating virtual care can improve access to comprehensive primary care. As the primary care sector works to recover from pandemic impacts and address population health needs, applying a patient-centred access framework during practice redesign offers a meaningful way to strengthen services.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100038"},"PeriodicalIF":0.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The COVID-19 pandemic changed healthcare delivery in multiple ways, including a widespread shift to virtual care. Evidence of how these changes were experienced is mixed and varies among populations and Canadian provinces. We sought to generate new information about how these changes were experienced by im/migrants in British Columbia (BC), assessing their impact on access to virtual and in-person primary care.
Methods
We conducted in-depth, semi-structured interviews in Dari, English, Farsi, Spanish, and Tigrinya with im/migrants living in BC for less than 10 years. We analyzed 50 interviews using a team-based approach to reflexive thematic analysis to explore how changes in service delivery in the context of the COVID-19 pandemic impacted im/migrant's healthcare experiences and access in BC.
Results
Interview participants described impacts of changes in service delivery in terms of accessibility, human connections, quality of care, and safety. Impacts were experienced positively as opportunities or negatively as obstacles. Experiences were shaped by immigration status, English language fluency, having a regular source of primary care before the pandemic, and economic resources. An overarching theme was trust, with healthcare experiences during the pandemic either increasing or decreasing participants’ trust in the healthcare system.
Conclusions
Our findings reveal that within im/migrant communities, the same changes in health service delivery were experienced differently, depending on various determining factors. Whether people experienced opportunities or obstacles, and increased or decreased trust, was shaped by modifiable policies that predate the pandemic and will persist beyond the pandemic unless significant and intentional, evidence-based changes are implemented.
{"title":"Ongoing impacts of the COVID-19 pandemic on access to primary care among im/migrant communities in British Columbia, Canada","authors":"Elmira Tayyar , Yasmin Bozorgi , Cecilia Sierra-Heredia , Hanah Damot , Ruth Carrillo , Stefanie Machado , Mei-ling Wiedmeyer , Shira Goldenberg , Ruth Lavergne","doi":"10.1016/j.ssmhs.2024.100037","DOIUrl":"10.1016/j.ssmhs.2024.100037","url":null,"abstract":"<div><h3>Background</h3><div>The COVID-19 pandemic changed healthcare delivery in multiple ways, including a widespread shift to virtual care. Evidence of how these changes were experienced is mixed and varies among populations and Canadian provinces. We sought to generate new information about how these changes were experienced by im/migrants in British Columbia (BC), assessing their impact on access to virtual and in-person primary care.</div></div><div><h3>Methods</h3><div>We conducted in-depth, semi-structured interviews in Dari, English, Farsi, Spanish, and Tigrinya with im/migrants living in BC for less than 10 years. We analyzed 50 interviews using a team-based approach to reflexive thematic analysis to explore how changes in service delivery in the context of the COVID-19 pandemic impacted im/migrant's healthcare experiences and access in BC.</div></div><div><h3>Results</h3><div>Interview participants described impacts of changes in service delivery in terms of accessibility, human connections, quality of care, and safety. Impacts were experienced positively as opportunities or negatively as obstacles. Experiences were shaped by immigration status, English language fluency, having a regular source of primary care before the pandemic, and economic resources. An overarching theme was trust, with healthcare experiences during the pandemic either increasing or decreasing participants’ trust in the healthcare system.</div></div><div><h3>Conclusions</h3><div>Our findings reveal that within im/migrant communities, the same changes in health service delivery were experienced differently, depending on various determining factors. Whether people experienced opportunities or obstacles, and increased or decreased trust, was shaped by modifiable policies that predate the pandemic and will persist beyond the pandemic unless significant and intentional, evidence-based changes are implemented.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100037"},"PeriodicalIF":0.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142425555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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