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Understanding the municipal-level design and adaptation of pay-for-performance schemes across two states of Brazil. 了解巴西两个州的市级绩效薪酬计划的设计和调整情况。
IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-08 DOI: 10.1093/heapol/czae033
Nasser Fardousi, Garibaldi Dantas Gurgel Junior, Helena Shimizu, Keila Silene de Brito E Silva, Everton Da Silva, Mariana Olivia Santana Dos Santos, Adriana Falangola Benjamin Bezerra, Luciano Gomes, Timothy Powell-Jackson, Juliana Sampaio, Josephine Borghi

The design of complex health systems interventions, such as pay for performance (P4P), can be critical to determining such programmes' success. In P4P programmes, the design of financial incentives is crucial in shaping how these programmes work. However, the design of such schemes is usually homogenous across providers within a given scheme. Consequently, there is a limited understanding of the strengths and weaknesses of P4P design elements from the implementers' perspective. This study takes advantage of the unique context of Brazil, where municipalities adapted the federal incentive design, resulting in variations in incentive design across municipalities. The study aims to understand why municipalities in Brazil chose certain P4P design features, the associated challenges and the local adaptations made to address problems in scheme design. This study was a multiple case study design relying on qualitative data from 20 municipalities from two states in Northeastern Brazil. We conducted two key informant interviews with municipal-level stakeholders and focus group discussions with primary care providers. We also reviewed municipal Primary Care Access and Quality laws in each municipality. We found substantial variation in the design choices made by municipalities regarding 'who was incentivized', the 'payment size' and 'frequency'. Design choices affected relationships within municipalities and within teams. Challenges were chiefly associated with fairness relating to 'who received the incentive', 'what is incentivized' and the 'incentive size'. Adaptations were made to improve fairness, mostly in response to pressure from the healthcare workers. The significant variation in design choices across municipalities and providers' response to them highlights the importance of considering local context in the design and implementation of P4P schemes and ensuring flexibility to accommodate local preferences and emerging needs. Attention is needed to ensure that the choice of 'who is incentivized' and the 'size of incentives' are inclusive and fair and the allocation and 'use of funds' are transparent.

复杂的卫生系统干预措施(如按绩效计薪)的设计对于决定此类计划的成败至关重要。在 P4P 计划中,经济激励措施的设计对这些计划如何发挥作用至关重要。然而,在某一计划中,不同提供方的计划设计通常是相同的。因此,从实施者的角度来看,对 "采购换进展 "计划设计要素优缺点的了解十分有限。本研究利用了巴西的独特背景,巴西各市对联邦激励机制的设计进行了调整,导致各市的激励机制设计各不相同。本研究旨在了解巴西各市选择某些 P4P 设计特点的原因、相关挑战以及为解决方案设计中的问题而进行的地方调整。本研究采用多案例研究设计,依靠来自巴西东北部两个州 20 个城市的定性数据。我们与市级利益相关者进行了两次关键信息访谈,并与初级保健提供者进行了焦点小组讨论。我们还审查了各市的 PMAQ 法律。我们发现,各市在 "激励对象"、"付款额度 "和 "频率 "方面的设计选择存在很大差异。设计选择影响了市政当局内部和团队内部的关系。面临的挑战主要与 "谁获得激励"、"激励什么 "和 "激励额度 "的公平性有关。为了提高公平性,主要是在医护人员的压力下进行了调整。各城市在设计方案上的巨大差异以及医疗服务提供者对这些方案的反应,都凸显了在设计和实 施 "病有所医 "计划时考虑当地情况并确保其灵活性以适应当地偏好和新需求的重要性。需要注意确保 "激励对象 "和 "激励规模 "的选择具有包容性和公平性,并确保资金的分配和 "使用 "具有透明度。
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引用次数: 0
Shifting roles of community health workers in the prevention and management of noncommunicable disease during the COVID-19 pandemic: a scoping review. 在 COVID-19 大流行期间,社区卫生工作者在预防和管理非传染性疾病方面的角色转变:范围审查。
IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-08 DOI: 10.1093/heapol/czae049
Tilahun Haregu, Peter Delobelle, Abha Shrestha, Jeemon Panniyammakal, Kavumpurathu Raman Thankappan, Ganeshkumar Parasuraman, Darcelle Schouw, Archana Ramalingam, Ayuba Issaka, Yingting Cao, Naomi Levitt, Brian Oldenburg

Community Health Workers (CHWs) play a crucial role in the prevention and management of noncommunicable diseases (NCDs). The COVID-19 pandemic triggered the implementation of crisis-driven responses that involved shifts in the roles of CHWs in terms of delivering services for people with NCDs. Strategically aligning these shifts with health systems is crucial to improve NCD service delivery. The aim of this review was to identify and describe COVID-19-triggered shifting roles of CHWs that are promising in terms of NCD service delivery. We searched Ovid Medline, Embase, CINAHL, Web of Science and CABI for Global Health for relevant articles published between 1 January 2020 and 22 February 2022. Studies that were conducted within a COVID-19 context and focused on the shifted roles of CHWs in NCD service delivery were included. We used Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines to report the findings. A total of 25 articles from 14 countries were included in this review. We identified 12 shifted roles of CHWs in NCD service delivery during COVID-19, which can be categorized in three dimensions: 'enhanced' role of CHWs that includes additional tasks such as medication delivery; 'extended' roles such as the delivery of NCD services at household level and in remote communities; and 'enabled' roles through the use of digital health technologies. Health and digital literacy of people with NCDs, access to internet connectivity for people with NCDs, and the social and organizational context where CHWs work influenced the implementation of the shifted roles of CHWs. In conclusion, the roles of CHWs have shifted during the COVID-19 pandemic to include the delivery of additional NCD services at home and community levels, often supported by digital technologies. Given the importance of the shifting roles in the prevention and management of NCDs, adaptation and integration of these shifted roles into the routine activities of CHWs in the post-COVID period is recommended.

社区保健工作者 (CHW) 在预防和管理非传染性疾病 (NCD) 方面发挥着至关重要的作用。COVID-19 大流行引发了以危机为导向的应对措施的实施,其中涉及社区保健员在为非传染性疾病患者提供服务方面的角色转变。战略性地将这些转变与卫生系统结合起来对于改善 NCD 服务的提供至关重要。本综述旨在确定并描述由 COVID-19 触发的、在提供非传染性疾病服务方面具有前景的社区保健员角色转变。我们在 Ovid Medline、Embase、CINAHL、Web of Science 和 CABI for Global Health 中检索了 2020 年 1 月 1 日至 2022 年 2 月 22 日期间发表的相关文章。我们纳入了在 COVID-19 背景下开展的研究,这些研究重点关注卫生保健工作者在提供非传染性疾病服务方面的角色转变。我们采用 PRISMA 指南来报告研究结果。本综述共纳入了来自 14 个国家的 25 篇文章。在 COVID-19 期间,我们确定了 12 项社区保健工作者在提供非传染性疾病服务方面的角色转变,这些转变可分为三个方面:社区保健工作者的强化角色,包括额外任务(如送药)、扩展角色(如在家庭层面和偏远社区提供非传染性疾病服务)以及通过使用数字医疗技术实现的角色。非传染性疾病患者的健康和数字素养、非传染性疾病患者获得互联网连接的机会以及社区保健员工作的社会和组织环境都影响着社区保健员角色转变的实施。总之,在 COVID-19 大流行期间,社区保健工作者的角色发生了转变,包括在家庭和社区层面提供更多的非传染性疾病服务,而且通常有数字技术的支持。鉴于角色转变在预防和管理非传染性疾病方面的重要性,建议在后 COVID 期间将这些转变后的角色调整和整合到卫生保健工作者的日常活动中。
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引用次数: 0
Correction to: The nature, drivers and equity consequences of informal payments for maternal and child health care in primary health centres in Enugu, Nigeria. 更正:尼日利亚埃努古初级保健中心母婴保健非正规付费的性质、驱动因素和公平后果。
IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-08 DOI: 10.1093/heapol/czae058
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引用次数: 0
'We thought supporting was strengthening': re-examining the role of external assistance for health systems strengthening in Zimbabwe post-COVID-19. 我们认为支持就是加强":重新审视外部援助在第 19 次协调、核查与发展会议后加强津巴布 韦卫生系统方面的作用。
IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-08 DOI: 10.1093/heapol/czae052
Alison T Mhazo, Charles C Maponga

Zimbabwe has received substantial external assistance for health since the early 2000s, including funding earmarked for, or framed as, health systems strengthening (HSS). This study sought to examine whether external assistance has strengthened the health system (i.e. enabled comprehensive changes to health system performance drivers) or has just supported the health system (by increasing inputs and improving service coverage in the short term). Between August and October 2022, we conducted in-depth key informant interviews with 18 individuals and reviewed documents to understand: (1) whether external funding has supported or strengthened Zimbabwe's health system since the 2000s; (2) whether the experience of COVID-19 fosters a re-examination of what had been considered as HSS during the pre-pandemic era; and (3) areas to be reconsidered for HSS post COVID-19. Our findings suggest that external funders have supported Zimbabwe to control major epidemics and avert health system collapse. However, the COVID-19 pandemic showed that supporting the health system is not the same as strengthening it, as it became apparent at that time that the health sector is plagued with several system-wide bottlenecks. External funding is fragile and highly unsustainable, which reinforces the oft-ignored reality that HSS is a sovereign mandate of country-level authorities, and one that falls outside the core interests of external funders. The key positive lesson from the pandemic is that Zimbabwe is capable of raising domestic resources to fund HSS. However, there is no guarantee that such funding will be maintained. There is a need, then, to reconsider government's stewardship for HSS. External funders need to re-examine whether their funding really strengthens the national health system or just supports the country to provide basic services in their areas of interest.

自 2000 年代初以来,津巴布韦在卫生领域获得了大量外部援助,其中包括指定用于加强卫生系统(HSS)的资金。本研究旨在探讨外部援助是加强了卫生系统(即实现了卫生系统绩效驱动因素的全面改变),还是仅仅支持了卫生系统(通过增加投入和在短期内提高服务覆盖率)。2022 年 8 月至 10 月间,我们对 18 位关键信息提供者进行了深入访谈,并查阅了相关文件,以了解:(1)自 2000 年代以来,外部资金是否支持或加强了津巴布韦的卫生系统;(2)COVID-19 的经验是否促使我们重新审视在疫情发生前被视为卫生系统服务的内容;以及(3)COVID-19 后卫生系统服务需要重新考虑的领域。我们的研究结果表明,外部资助者支持津巴布韦控制重大流行病,避免卫生系统崩溃。然而,COVID-19 大流行表明,支持卫生系统并不等于加强卫生系统,因为当时卫生部门显然面临着几个全系统瓶颈。外部供资十分脆弱,而且极难持续,这强化了一个经常被忽视的现实,即卫生和保健服务是国家一级当局的主权任务,不属于外部供资者的核心利益。从这次大流行病中吸取的主要积极教训是,津巴布韦有能力筹集国内资源来资助人道主义服务。然而,并不能保证这种资金能够得到维持。因此,有必要重新考虑政府对人文社科的管理。外部资助者需要重新审视他们的资助是否真正加强了国家卫生系统,还是仅仅支持国家在他们感兴趣的领域提供基本服务。
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引用次数: 0
Factors associated with financial risk due to health spending in Argentina. 阿根廷与医疗支出造成的财务风险相关的因素。
IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-08 DOI: 10.1093/heapol/czae051
Juan Marcelo Virdis, María Eugenia Elorza, Fernando Delbianco

This article aims to assess the association between household demographic and socioeconomic characteristics and catastrophic health expenditure (CHE) in Argentina during 2017-2018. CHE was estimated as the proportion of household consumption capacity (using both income and total consumption in separate estimations) allocated for Out-of-Pocket (OOP) health expenditure. For assessing the determinants, we estimated a generalized ordered logit model using different intensities of CHE (10%, 15%, 20% and 25%) as the ordinal dependent variable, and socioeconomic, demographic and geographical variables as explanatory factors. We found that having members older than 65 years and with long-term difficulties increased the likelihood of incurring CHE. Additionally, having an economically inactive household head was identified as a factor that increases this probability. However, the research did not yield consistent results regarding the relationship between public and private health insurance and consumption capacity. Our results, along with the robustness checks, suggest that the magnitude of the coefficients for the household head characteristics could be exaggerated in studies that overlook the attributes of other household members. In addition, these results emphasize the significance of accounting for long-term difficulties and indicate that omitting this factor could overestimate the impact of members aged over 65.

本文旨在评估2017-2018年间阿根廷家庭人口和社会经济特征与灾难性医疗支出(CHE)之间的关联。灾难性医疗支出被估算为家庭消费能力(在单独估算中使用收入和总消费)中用于自付医疗支出(OOP)的比例。为评估决定因素,我们使用不同强度的 CHE(10%、15%、20% 和 25%)作为序数因变量,并使用社会经济、人口和地理变量作为解释因素,估算了一个广义有序对数模型。我们发现,家庭成员年龄超过 65 岁且长期生活困难会增加发生 CHE 的可能性。此外,户主不从事经济活动也被认为是增加这种可能性的一个因素。然而,关于公共和私人医疗保险与消费能力之间的关系,研究结果并不一致。我们的研究结果以及稳健性检验结果表明,在忽略其他家庭成员属性的研究中,户主特征系数的大小可能会被夸大。此外,这些结果还强调了考虑长期困难的重要性,并表明忽略这一因素可能会高估 65 岁以上成员的影响。
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引用次数: 0
Bilateral health agreements of South Africa: an analysis of issues covered. 南非双边卫生协定:所涉问题分析。
IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-08 DOI: 10.1093/heapol/czae038
Johanna Hanefeld, Moeketsi Modisenyane, Jo Vearey, Neil Lunt, Richard Smith, Helen Walls

The bilateral agreements signed between South Africa and countries in Southern and Eastern Africa are a rare example of efforts to regulate health-related issues in a world region. As far as we know, there are no comparable bilateral health governance mechanisms in regions elsewhere. Furthermore, the rapidly growing literature on global health governance and governance for global health has to date not addressed the issue of patient mobility and how to govern it. In this study, we examine the issues included in these agreements, highlight key issues that they address, identify areas of omission and provide recommendations for improvement. This analysis should inform the development of such governance agreements both in Southern Africa and in regions elsewhere. We obtained 13 bilateral health agreements between South Africa and 11 neighbouring African countries as part of a broader research project examining the impact on health systems of patient mobility in South Africa, and thematically analysed their content and the governance mechanisms described. The agreements appear to be solidarity mechanisms between neighbouring countries. They contain considerable content on health diplomacy, with little on health governance, management and delivery. Nonetheless, given what they do and do not address, and how, they provide a rare insight into mechanisms of global health diplomacy and attempts to address patient mobility and other health-related issues in practice. The agreements appear to be global health diplomacy mechanisms expressing solidarity, emerging from a post-apartheid period, but with little detail of issues covered, and a range of important issues not addressed. Further empirical work is required to understand what these documents mean, particularly in the Covid-19 context, and to understand challenges with their implementation. The documents also raise the need for particular study of bilateral flows and experience of patients and health workers, and how this relates to health system strengthening.

南非与南部非洲和东部非洲国家签署的双边协定是努力管理一个地区卫生相关问题的罕见范例。据我们所知,其他地区还没有类似的双边卫生治理机制。此外,有关全球卫生治理和全球卫生治理的文献迅速增加,但迄今为止,这些文献尚未涉及病人流动性问题以及如何治理这一问题。在本研究中,我们对这些协议中包含的问题进行了研究,并强调了这些协议所涉及的关键问题,找出了其中的疏漏之处,并提出了改进建议。这项分析将为南部非洲和其他地区制定此类管理协议提供参考。我们获得了 13 份南非与 11 个非洲邻国之间的双边医疗协议,作为研究南非病人流动性对医疗系统影响的更广泛研究项目的一部分,并对其内容和所述治理机制进行了专题分析。这些协议似乎是邻国之间的团结机制。它们包含了大量有关卫生外交的内容,但很少涉及卫生治理、管理和提供。尽管如此,考虑到这些协议涉及和不涉及的内容,以及如何涉及,它们为全球卫生外交机制以及在实践中解决病人流动和其他卫生相关问题的尝试提供了难得的启示。这些协议似乎是后种族隔离时期出现的表达团结的全球卫生外交机制,但所涵盖问题的细节很少,而且有一系列重要问题没有得到解决。需要进一步开展实证工作,以了解这些文件的含义,特别是在 Covid-19 的背景下,并了解其实施过程中遇到的挑战。这些文件还提出需要特别研究病人和卫生工作者的双边流动和经验,以及这与加强卫生系统的关系。
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引用次数: 0
The social lives of point-of-care tests in low- and middle-income countries: a meta-ethnography. 中低收入国家护理点检测的社会生活:元民族志。
IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-08 DOI: 10.1093/heapol/czae054
Janet Perkins, Clare Chandler, Ann Kelly, Alice Street

Point-of-care tests (POCTs) have become technological solutions for many global health challenges. This meta-ethnography examines what has been learned about the 'social lives' of POCTs from in-depth qualitative research, highlighting key social considerations for policymakers, funders, developers and users in the design, development and deployment of POCTs. We screened qualitative research examining POCTs in low- and middle-income countries and selected 13 papers for synthesis. The findings illuminate five value-based logics-technological autonomy, care, scalability, rapidity and certainty-shaping global health innovation ecosystems and their entanglement with health systems. Our meta-ethnography suggests that POCTs never achieve the technological autonomy often anticipated during design and development processes. Instead, they are both embedded in and constitutive of the dynamic relationships that make up health systems in practice. POCTs are often imagined as caring commodities; however, in use, notions of care inscribed in these devices are constantly negotiated and transformed in relation to multiple understandings of care. POCTs promise to standardize care across scale, yet our analysis indicates nonstandard processes, diagnoses and treatment pathways as essential to 'fluid technologies' rather than dangerous aberrations. The rapidity of POCTs is constructed and negotiated within multiple distinct temporal registers, and POCTs operate as temporal objects that can either speed up or slow down experiences of diagnosis and innovation. Finally, while often valued as epistemic tools that can dispel diagnostic uncertainty, these papers demonstrate that POCTs contribute to new forms of uncertainty. Together, these papers point to knowledge practices as multiple, and POCTs as contributing to, rather than reducing, this multiplicity. The values embedded in POCTs are fluid and contested, with important implications for the kind of care these tools can deliver. These findings can contribute to more reflexive approaches to global health innovation, which take into account limitations of established global health logics, and recognize the socio-technical complexity of health systems.

床旁检测(POCT)已成为应对许多全球健康挑战的技术解决方案。这篇元民族志探讨了深入的定性研究对 POCTs "社会生活 "的揭示,强调了政策制定者、资助者、开发者和用户在设计、开发和部署 POCTs 时应考虑的关键社会因素。我们对中低收入国家(LMICs)的 POCT 定性研究进行了筛选,选出了 13 篇论文进行综合。研究结果阐明了五种基于价值的逻辑--技术自主性、护理、可扩展性、快速性和确定性--塑造了全球卫生创新生态系统及其与卫生系统的联系。我们的元人类学研究表明,在设计和开发过程中,POCT 从未实现通常预期的技术自主性。相反,在实践中,它们既嵌入到构成卫生系统的动态关系中,又是这种动态关系的组成部分。POCT 通常被想象为护理商品;然而,在使用过程中,这些设备所体现的护理概念会根据对护理的多种理解而不断进行协商和转变。POCTs 承诺在各种范围内实现护理标准化,但我们的分析表明,非标准的流程、诊断和治疗路径对 "流动技术 "至关重要,而不是危险的反常现象。POCT 的快速性是在多种不同的时间范围内构建和协商的,POCT 作为时间对象,既可以加快也可以放慢诊断和创新的体验。最后,尽管 POCT 通常被视为能够消除诊断不确定性的认识论工具,但这些论文表明,POCT 助长了新形式的不确定性。这些论文共同指出,知识实践是多重的,POCTs 是促进而不是减少多重性。POCT 所蕴含的价值是流动的、有争议的,对这些工具所能提供的医疗服务具有重要影响。这些发现有助于对全球卫生创新采取更具反思性的方法,这种方法考虑到了既有全球卫生逻辑的局限性,并认识到了卫生系统的社会技术复杂性。
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引用次数: 0
Editor-in-Chief changes at Health Policy and Planning. 卫生政策与规划》主编变动。
IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-08 DOI: 10.1093/heapol/czae037
Sandra Mounier-Jack, Virginia Wiseman, Lucy Gilson
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引用次数: 0
The impacts of task shifting on the management and treatment of malnourished children in Northern Kenya: a cluster-randomized controlled trial. 任务转移对肯尼亚北部营养不良儿童管理和治疗的影响:分组随机对照试验》。
IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-08 DOI: 10.1093/heapol/czae036
Hermann Pythagore Pierre Donfouet, Tewoldeberhan Daniel, Calistus Wilunda, Elizabeth Mwaniki, James Njiru, Emily Keane, Lily Schofield, Lucy Maina, Edward Kutondo, Olivia Agutu, Peter Okoth, Judith Raburu, Betty Samburu, Bonventure Mwangi, Taddese Alemu Zerfu, Jemimah Wekhomba Khamadi, Pilar Charle Cuellar, Daniel Kavoo, Lydia Karimurio, Charles Matanda, Alex Mutua, Grace Gichohi, Martin Chabi, Patrick Codjia, Saul Guerrero Oteyza, Elizabeth Kimani-Murage

Treating children with acute malnutrition can be challenging, particularly regarding access to healthcare facilities during treatment. Task shifting, a strategy of transferring specific tasks to health workers with shorter training and fewer qualifications, is being considered as an effective approach to enhancing health outcomes in primary healthcare. This study aimed to assess the effectiveness of integrating the treatment of acute malnutrition by community health volunteers into integrated community case management in two sub-counties in northern Kenya (Loima and Isiolo). We conducted a two-arm non-inferiority cluster-randomized controlled trial across 20 community health units. Participants were children aged 6-59 months with uncomplicated acute malnutrition. In the intervention group, community health volunteers used simplified tools and protocols to identify and treat eligible children at home and provided the usual integrated community case management package. In the control group, community health volunteers provided the usual integrated community case management package only (screening and referral of the malnourished children to the health facilities). The primary outcome was recovery (MUAC ≥12.5 cm for 2 consecutive weeks). Results show that children in the intervention group were more likely to recover than those in the control group [73 vs 50; risk difference (RD) = 26% (95% CI 12 to 40) and risk ratio (RR) = 2 (95% CI 1.2 to 1.9)]. The probability of defaulting was lower in the intervention group than in the control group: RD = -21% (95% CI -31 to -10) and RR = 0.3 (95% CI 0.2 to 0.5). The intervention reduced the length of stay by about 13 days, although this was not statistically significant and varied substantially by sub-county. Integrating the treatment of acute malnutrition by community health volunteers into the integrated community case management programme led to better malnutrition treatment outcomes. There is a need to integrate acute malnutrition treatment into integrated community case management and review policies to allow community health volunteers to treat uncomplicated acute malnutrition.

对患有急性营养不良的儿童进行治疗具有挑战性,尤其是在治疗过程中使用医疗设施方面。任务转移是一种将特定任务转移给受训时间较短、资质较低的卫生工作者的策略,被认为是提高初级卫生保健成果的有效方法。本研究旨在评估将社区卫生志愿者治疗急性营养不良纳入肯尼亚北部两个县(洛伊马和伊西奥洛)综合社区病例管理的效果。我们在 20 个社区卫生单位开展了一项双臂非劣效性分组随机对照试验。参与者为 6-59 个月大的无并发症急性营养不良儿童。在干预组中,社区卫生志愿者使用简化的工具和方案在家中识别和治疗符合条件的儿童,并提供常规的综合社区病例管理套餐。在对照组中,社区卫生志愿者只提供常规的社区综合病例管理方案(筛查营养不良儿童并将其转诊至医疗机构)。主要结果是痊愈(MUAC 连续两周≥12.5 厘米)。结果显示,干预组儿童比对照组儿童更有可能康复[73 对 50;风险差异 (RD)=26% (95% CI 12 至 40),风险比 (RR)=2 (95% CI 1.2 至 1.9)]。干预组的违约概率低于对照组:RD=-21% (95% CI -31 to -10),RR=0.3 (95% CI 0.2 to 0.5)。干预措施使住院时间缩短了约 13 天,尽管这在统计学上并不显著,而且各县分区的情况也大不相同。将社区卫生志愿者对急性营养不良的治疗纳入社区综合病例管理计划后,营养不良的治疗效果更好。有必要将急性营养不良治疗纳入综合社区病例管理,并对政策进行审查,允许社区卫生志愿者治疗无并发症的急性营养不良。
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引用次数: 0
What explains the provision of health insurance by Indonesian employers? A trend analysis of the National Labour Force Survey 2018-2022. 印度尼西亚雇主提供医疗保险的原因是什么?2018-2022年全国劳动力调查趋势分析》。
IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-08 DOI: 10.1093/heapol/czae053
Levina Chandra Khoe, Muchtaruddin Mansyur, Virginia Wiseman, Augustine Asante

Indonesian laws mandate that every employer should provide health insurance and work accident insurance to their employees. Nevertheless, there is a significant gap in the coverage of employer-sponsored insurance among Indonesian workers. This study examines the coverage of employer-sponsored insurance and work accident insurance and analyses the characteristics of the uninsured working population in Indonesia. We analysed nationally representative cross-sectional data from the National Labour Force Survey (NLFS) conducted between 2018 and 2022. The primary dependent variable was the provision of health insurance and work accident insurance by employers. The independent variables included having any physical disabilities, number of working hours, duration of employment, labour union membership, earning at least the provincial minimum wage, having a written contract and working in high risk jobs. Logistic regression was employed using the R statistical software. The findings indicate that coverage of employer-sponsored health insurance is low in Indonesia-ranging from 36.1% in 2018 to 38.4% in 2022. Workers with a written contract, earning at least the provincial minimum wage, were members of a labour union, employed for at least 5 years and working more than 40 hours a week were more likely to be insured. By contrast, workers who had physical disabilities or were employed in high-risk jobs were less likely to be insured. Our study concludes that having a written employment contract is the single most influential factor that explains the provision of employer-sponsored health insurance in Indonesia. The country's labour laws should therefore formalize the provision of written employment contracts for all workers regardless of the type and nature of work. The existing laws on health insurance and work accident insurance should be enforced to ensure that employers meet their constitutionally mandated obligation of providing these types of insurance to their workers, particularly those engaged in high risk jobs.

印度尼西亚法律规定,每个雇主都应为其雇员提供医疗保险和工伤事故保险。然而,在印尼工人中,雇主资助保险的覆盖面还存在很大差距。本研究调查了印尼雇主资助保险和工伤事故保险的覆盖率,并分析了印尼未参保工作人口的特征。我们分析了 2018-2022 年间进行的全国劳动力调查(NLFS)中具有全国代表性的横截面数据。主要因变量是雇主提供医疗保险和工伤保险的情况。自变量包括是否有任何身体残疾、工作时数、就业期限、工会会员身份、收入至少达到省最低工资标准、是否签订书面合同以及是否从事高风险工作。使用 R 统计软件进行了逻辑回归。研究结果表明,印尼雇主资助的医疗保险覆盖率较低,从2018年的36.1%到2022年的38.4%不等。有书面合同、收入至少达到省最低工资标准、是工会成员、受雇至少5年、每周工作40小时以上的工人更有可能获得保险。相比之下,身体残疾或从事高风险工作的工人投保的可能性较低。我们的研究得出结论,在印尼,拥有书面雇佣合同是解释雇主资助医疗保险提供情况的唯一最具影响力的因素。因此,印尼的劳动法应正式规定,无论工作类型和性质如何,所有工人都应签订书面雇佣合同。应执行有关医疗保险和工伤事故保险的现行法律,以确保雇主履行《宪法》规定的义务,为其工人,尤其是从事高风险工作的工人提供这些类型的保险。
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Health policy and planning
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