International Journal of Health Planning and Management最新文献

Mozambique introduced its cervical cancer screening programme in 2009, but only 3.5% of the target women participate in screening annually. While previous research has focused on provision and access to service, and women's cognitive barriers to screening, this study explores the emotional factors, particularly pudor, that affect women's acceptance of screening. Using an institutional work perspective, we conducted an explanatory case study involving documental analysis and primary data collection through semi-structured interviews, focus group discussions, direct observations, and informal conversations with 121 participants, including women, health professionals, and family members from Xai-Xai in Southern Mozambique. Our findings reveal that pudor, an emotion tied to a deep-seated sense of reserve rooted in patriarchal culture and masculine dominance, plays a significant role in limiting women's motivation to participate in screening. This emotion, shaped by social and cultural norms around privacy, intimacy, and sexuality, leads women to view cervical cancer screening as culturally unacceptable, often responding with attitudes emphasising modesty and avoidance. These findings underscore the importance of addressing emotional factors in health care strategies and considering the sociocultural context that influences health behaviours.

Background: Though an important component of high-quality healthcare, the routine collection of patient experience data is limited in primary care, as is the evidence for how this data is being used for quality improvement. This study used a learning health system (LHS) framework to describe how a university-affiliated community general practice is integrating patient experience data into service and quality improvement efforts, and to identify barriers and facilitators.

Methods: A co-designed qualitative case study was conducted with academic researchers and staff from a university-affiliated general practice in Australia. Semi-structured interviews were conducted in April 2024 with practice staff, and transcripts were deductively coded according to a five-domain learning health systems framework, and with additional codes capturing barriers and facilitators.

Results: Eighteen (53%) practice staff were interviewed, including general practitioners (n = 11), a practice nurse (n = 1), and administrative staff (n = 6). Participants identified multiple methods through which the practice captured the patient experience that spanned all domains of the LHS framework. However, there was less evidence of a coherent quality improvement strategy being employed, with associated barriers identified around staff workloads, training, and existing government funding policies. Key facilitators to the use of patient experience data included: membership of a larger health organisation and university; key dedicated administrative and clinical roles; and effective leadership, governance structures and policies to support continuous learning and drive service improvement.

Conclusion: This study presents a case example of how patient experience data is being integrated into general practice and identifies key barriers and facilitators to initiating and translating this data for continuous healthcare improvement. By mapping the use of patient experience data to a LHS framework, this study shows how LHS principles can be applied to primary care to facilitate the capture and use of patient experience data on an ongoing basis.

Emergency events such as natural disasters, pandemics, and other health disasters have a predictably disproportionate impact on vulnerable populations and the COVID-19 pandemic was not an exception. To respond to potentially catastrophic consequences of COVID-19 and to build an infrastructure for a more inclusive recovery, in June 2020, the Chicago Department of Public Health partnered with a state university school of public health, a community college that prepares students for healthcare occupations, a research institute at a private university, a public health institute affiliated with a hospital system, and a workforce development organisation. The team formed the Chicago COVID-19 Contact Tracing Corps (ChiTracing). Centring the expertise of grassroots community-based organisations (CBOs), ChiTracing partnered with 31 CBOs operating in the highest hardship community areas. These CBOs hired and trained over 500 community members, who had a history of unemployment, as neighbourhood-level public health ambassadors and contact tracers, known as the ChiTracing Corps members. Informed by a shared theory of change, we brought three strategies to this work: investing in a new public health infrastructure by centring trusted CBOs and people with lived experience of systems of oppression as part of the public health system, increasing awareness and knowledge of public health and available resources for the most vulnerable, and fostering relationships and power building among diverse collaborators. In this paper, we highlight lessons learnt and share insights on how future efforts can bring collaborative, inclusive approaches to public health workforce development.

Birth Defects (BDs) are a significant contributor to childhood mortality worldwide, yet BD surveillance and management in Low and Middle-Income Countries (LMICs) like India remain under-prioritised. This article presents findings from a population-based BD surveillance conducted in the Palghar district, Maharashtra, India, aimed at identifying challenges and solutions in the implementation of BD surveillance. The data on BDs was collected between April 2021 and March 2023 from 38 Primary Health Centres (PHCs), nine Rural Hospitals (RH) and three Sub-district Hospitals (SDH) from seven tribal blocks of Palghar district. A total of 402 BDs were identified during the study period through facility and community-based approaches. Certain challenges were encountered at different levels of surveillance including underreporting by healthcare workers (ASHAs), non-functional District Early Intervention Centres (DEICs), a non-operational web portal for data entry and parenteral barriers attributing to screening, referral and management of BDs. Measures were taken to overcome these challenges comprising refresher training for ASHAs, the creation of communication channels and the distribution of educational materials. These initiatives encouraged and significantly improved the reporting of Visible BDs (VBDs) through ASHAs and programs (Rashtriya Bal Swasthya Karyakram) at the end of the reporting period. This study highlights that addressing these system shortcomings could be effectively achieved through intersectoral coordination and the involvement of Health Care Workers (HCWs) aligning with programme objectives. It further underscores the need for improved infrastructure and training to enhance BD surveillance effectiveness in South Asian countries, especially in tribal regions.

Nigeria's 2024 National Policy on Health Workforce Migration confronts a fundamental challenge: rebuilding trust between healthcare workers and government. Using Mayer, Davis, and Schoorman's organizational trust framework, this analysis explores how trust shapes healthcare workers' migration decisions. Drawing from comparative African experiences and implementation evidence, this paper argues that without addressing core issues of trust through demonstrated policy implementation, sustained commitment to workforce welfare, and competitive compensation, even well-designed retention policies will struggle to retain Nigeria's health workers.

Background: Effective management of crises is a major challenge for healthcare organisations and their managers. Research suggests that to respond to evolving and unpredictable crises, such as the Covid-19 pandemic, an organisation needs the capability to continually adapt to the changing situation using relevant knowledge. However, there are few empirical studies using an organisational resilience perspective to understand how a health system responds to this type of crisis. This study aimed to describe managers' perspectives on what influenced the response to the Covid-19 pandemic in the Region Stockholm healthcare system for older people.

Methods: Data collection was conducted through in-depth semi-structured interviews with assistant managers (n = 3) and managers of inpatient geriatric services outside of acute care hospitals (n = 8), managers of three acute care hospitals (n = 3); and the crisis management team for geriatric services (n = 3). Data was analysed using qualitative content analysis.

Results: Crisis management of geriatric care in the Stockholm healthcare system during the Covid-19 pandemic's first 15 months was influenced by a combination of service specific aspects, 'Internal flexible responses', collaborative aspects, 'Coordination within the system', and governance aspects 'Adaptive steering'.

Conclusions: This study contributes to empirical knowledge about organisational resilience. Managers' responses are facilitated when the governance allow them more flexibility in their internal responses and enable their cross-organisational collaboration. A coordinating function across healthcare services is an important enabler in a crisis when the function has well-established, trustful prior collaborations with the services.

Over the past two decades, patient-centred care has gained global prominence, emphasising collaboration among patients, families, caregivers, and healthcare professionals to improve healthcare delivery. Recognising the foundational role of patient participation in enhancing clinical outcomes, healthcare organisations increasingly integrate patient inputs and resources into their management strategies. Patient and family advisory councils represent a primary form of collective patient engagement at the organisational level. Patient and family advisory councils actively engage in all levels of the hospital system to enhance quality improvement and meet the demands of patients. Despite recognised importance, empirical evidence regarding their roles as strategic resources and impact on hospital performance remains unexplored. Incorporating patient engagement into the social resource-based view, this study addresses how comprehensive strategic resources are associated with a hospital's quality of care and patient satisfaction outcomes. Utilising hospital-level data from 2018 to 2020, a cross-sectional time-series ordered logit analysis examines the quality of care and patient satisfaction models. The findings reveal that patient engagement, physical resources, and human capital are positively associated with hospital quality of care and patient satisfaction. In contrast, a social resource-a minority population-is negatively associated with hospital outcomes. This study contributes theoretical and practical implications. It synthesises patient engagement into the Social Resource-Based approach and provides consistent empirical evidence. In addition, it suggests evidence for practitioners to develop and manage patient engagement as a strategic resource.

The integration of health programms in low-resource settings is a common approach aimed at providing quality and cost-effective healthcare services. However, programme integration can unintentionally impact service provision and disrupt the overall organisation of service delivery. In this paper, I examine the integrated programme for non-communicable diseases (NCDs) and explore the challenges related to the deployment of health workers. Specifically, I investigate the institutional processes that shape the work of health workers and the working conditions in district hospitals. To explore the social organisation of the implementation of the integrated NCD programme, I employed institutional ethnography as a research method. Data collection involved interviews, participant observation, and document reviews. Data analysis was conducted using social mapping, analytical writing, and textual analysis methods. The findings of the study suggest that due to staff shortages and a lack of doctors, health workers are continuously subjected to deployment and often required to undertake multiple tasks and responsibilities without any incentives or non-monetary benefits. Administrators perceive health workers in integrated programs as additional human resources available for use in district hospitals. However, the removal of health workers from integrated programs can have negative implications for service delivery and patients' health outcomes. Finding of the study suggests that it is recommended that administrators improve the staff recruitment process and promptly address the grievances of health workers to enhance healthcare delivery.