Sante Publique最新文献

Introduction: Results-based financing (RBF) was presented by its advocates as an effective tool for improving Burkina Faso's health care system, and an essential step toward implementing universal health coverage (UHC) in the country. It was initially introduced in 2011, and suspended in 2018.

Purpose of the study: Using a conceptual framework built around the triptych of the causes, mechanisms, and outcomes of institutional change, we sought to understand how RBF was introduced in Burkina Faso, and how it contributed to the country's drive to implement UHC.

Results: RBF was perceived as an external policy, essentially advocated by the World Bank. It relied on a group of actors operating outside the organizational structure of the Ministry of Health. Its impact on health indicators and the health care system has been mixed, and it has not enabled the country to put itself on a path to implementing UHC. It was not adopted by the key actors in the health care system, which is why it was discontinued without being rolled out at the national level.

Conclusions: This study highlights the need to take the local context into account when designing and implementing health care programs.

Objective: To determine the reasons for using a digital exercise tool during lockdown, and change in this use after lockdown.

Methods: This study followed 196 individuals during and after lockdown. An online questionnaire collected quantitative and qualitative data. The quantitative data included closed-ended questions evaluating factors influencing the use of digital tools for exercising, digital tool usage, physical activity levels, and sitting time. The qualitative data comprised open-ended questions about the reasons for digital tool usage, taking a "multiple-lives" perspective by examining continuity, change of tool, discontinuous use, or stopping use.

Results: The quantitative data showed that digital tool users were young adults with a high level of education. Half of these individuals used a digital tool for the first time during lockdown. Post-lockdown, about 82% of the participants stopped using digital tools. The perceived usefulness of these tools during the COVID-19 period was a key driver of usage. The qualitative data revealed that the primary reasons for using digital tools during lockdown were the need for expert advice and programs, and a lack of motivation for home-based exercise.

Conclusions: The closure of sports facilities during lockdown produced a substantial shift toward the use of digital technologies for maintaining physical activity. However, as the lockdown measures were relaxed, usage of these technologies declined. This underscores the importance of further scrutinizing the quality and effectiveness of these tools, many of which are freely available, in order to ensure their suitability for public health and fitness programs.

Objective: This study aimed to evaluate the technical efficiency and change in productivity of 120 public hospitals (établissements publics hospitaliers, EPH) in Algeria over the period 2011-2020, along with the factors influencing this efficiency.

Methods: To measure efficiency scores, we used the output-oriented data envelopment analysis (DEA) method, based on the hypothesis of variable returns to scale. We also used the Malmquist index to assess changes in efficiency and productivity over the years, and the Simar-Wilson model to assess the determinants of efficiency.

Results: The average efficiency scores for the study period were 0.788 and 0.710 in the classic DEA and bootstrap DEA models, respectively. Regarding the Malmquist index, we observed a 3% decline in total factor productivity during the study period, but an improvement in technical efficiency of 0.3%. As for the determinants of efficiency, six variables (bed occupancy rate, average length of stay, number of beds per doctor, number of beds per thousand inhabitants, number of doctors per thousand inhabitants, and budget) were significant.

Conclusion: The results show an overall improvement in the technical performance of public hospitals during the study period. However, a decline in total factor productivity was observed over the same period, mainly due to technological change.

Introduction: Promoting the health of adults in mid-life, using a population-based and multifactorial approach, has until recently been poorly covered by public policy, despite the fact that the health indicators for such adults give cause for concern. This period of life also represents an opportunity to initiate changes in behaviour before the onset of disease. Against this backdrop, Santé publique France, together with its Steering and Dialogue Committee, has decided to launch an advocacy approach aimed at stakeholders working in and for the French regions.

Aim of the study: To develop an 'advocacy' medium that includes the stages of multi-stakeholder construction required to identify the representations and perceived health problems present in the regions, the role that each stakeholder plays, as well as the health promotion tools and strategies already in place. To achieve this, Santé publique France carried out a qualitative survey of local stakeholders by means of semi-structured interviews and set up stakeholder consultation initiatives.

Results: The methodology chosen is aimed at transferring epidemiological data, promoting the key actions arising from the qualitative survey and presenting the essential role played by the stakeholders working in and for the regions. It reflects the complexity of the population-based approach to mid-life adults in a context of multi-level responsibilities, characteristic of public health policies.

Discussion: The results underline the legitimacy of Santé publique France's advocacy role in encouraging local stakeholders to work towards improving the health of mid-life adults, particularly the socio-economically disadvantaged.

In a post-health crisis context that has affected children's mental health and well-being, a territorial analysis confirms these observations and highlights concerns about addictive behaviour among young people. Based on this fact, a dynamic partnership between various players has been created in order to build a joint action. The aim of the project is to raise awareness among professionals working in childcare and early childhood structures of the importance of developing psychosocial competencies, so as to influence their development and children's health. This study allows - through intervention analysis - to understand the issues, levers and obstacles to partnership collaboration and the co-construction work carried out by all the players involved. Despite the obstacles encountered, the results demonstrate the added value of this approach and highlight the determining factors in its success.

Objective: Pregnancy monitoring in France includes an early prenatal interview (EPP), to assess with the pregnant woman any needs she may have for support during her pregnancy. The aim was to study the factors associated with the absence of an EPP.

Methods: The study population corresponded to women with a live birth in metropolitan France who answered the question about the EPP in the ENP 2021 (n=10,925). Individual factors and health offer were analysed using Chi-square tests and multivariate mixed logistic regression.

Results: Over 60% of women reported not having had an EPP or that they didn’t know. Women under 25 years of age (adjusted OR= 1.30, 95%IC[1.10-1.55]), or not French nationality (ORa=2.10 [1.61-2.73] if North African nationality), or with a level of education lower than high school (ORa=2.17 [1.86-2.54]), had a higher probability of declaring that they had not had an EPP. Compared with women attended by a private midwife, women attended by a private or public obstetrician-gynaecologist (ORa=1.81 [1.62-2.03] ; ORa=1.66 [1.42-1.95]), a general practitioner (ORa=1.62 [1.29-2.04]) or a midwife in a maternity (ORa=1.19 [1.03-1.37]) more often reported not having had an EPP, as well as women living in a department with a low density of private midwives (ORa=1.51 [1.11-2.05]).

Discussion: Raising awareness and training healthcare professionals in EPP are key to its deployment, as there are social inequalities in the way it is currently practised. Particular attention needs to be paid to the most vulnerable socio-economic groups.