Service Delivery

Community health care services provide vital care out of hospital for millions of people. From children’s services to care for older people and end-of-life support, the community sector plays a key part in meeting the challenges facing our health and care system. This report presents findings from a small-scale study into how quality is managed in community services. It explores how community care providers define and measure quality and recommends important next steps to support better measurement and management of quality. [from introduction]

Whole-system interventions are those that entail system wide changes in goals, service delivery arrangements and relationships between actors, requiring approaches to implementation that go beyond projects or programmes. Drawing on concepts from complexity theory, this paper describes the catalysts to implementation of a whole-system intervention in the North West Province of South Africa.

We explore whether social exclusion determines enrolment of older people in Senegal’s Plan Sesame and Ghana’s NHIS. Social exclusion affects older people’s uptake of social health protection (SHP) programs in both Senegal and Ghana. Reducing financial barriers is not enough to achieve universal coverage.Efforts to cover older people at risk of social exclusion should be increased. Sociocultural, political and economic dimensions should be considered while designing SHP schemes. [from abstract]

The use of community health workers to administer prompt treatments is gaining popularity in most sub-Saharan African countries. Their performance is a key challenge because it varies considerably, depending on the context, while being closely associated with the effectiveness of case management strategies. What determines community health workers’ performance is still under debate. Based on a realist perspective, a systematic review recently hypothesized that several mechanisms are associated with good performance and successful community interventions.

This study investigated whether increased numbers of primary healthcare clinical consultations in Indigenous communities in some remote areas of Australia are associated with the reduced need for urgent medical evacuations and remote telephone consultations. [from abstract]

The objective of this research was to analyze the organizational culture of a Brazilian public hospital. It is a descriptive study with quantitative approach of data, developed in a public hospital of São Paulo State, Brazil. [from abstract]

The Outcome Report of the Global Consultation on Population Dynamics and the Post-2015 Development Agenda not only explains the linkages between today’s most pressing development challenges, population dynamics and sexual and reproductive health and rights, but also provides concrete recommendations on how to address these linkages in the post-2015 development agenda. To date, this report makes the clearest and strongest case for why population matters for the post-2015 development agenda and for why the ICPD Programme of Action must be firmly integrated into this new agenda. [from abstract]

The Partnership for Reviving Routine Immunization in Northern Nigeria - Maternal, Newborn and Child Health initiative supports efforts by the government of Nigeria to bridge primary health care (PHC) policies and services at three levels of government: federal, state and local. The paper suggests that understandings informed by complexity theory and complex adaptive systems have been helpful in shaping policy and programme design across these levels. [from abstract]

India faces enormous challenge in human resources for health care delivery system. Geographical misdistribution and urban-rural health worker deficit impedes the progress towards achieving Millennium Development Goals. Many rural Indians receive health care from unqualified providers. Rational distribution and retention of qualified providers in rural and remote areas is a daunting task for the government. Little attention is paid in public medical institutions for the real health needs of the community. [from abstract]

This report is not just a summary of a USAID-funded project: It is an extensively-documented milestone for global efforts to improve health in lower- and middle-income countries (LMICs). Increasingly, the central strategy for global health efforts to save lives focuses on selected, high impact interventions. Organizations have
supported these interventions chiefly by providing the required resources, such as training, drugs, and technical
assistance. But in order to implement any kind of service, the health system uses standardized processes for both
clinical and non-clinical activities.

The World Health Organization (WHO) has developed a new strategy on people-centered health care that places a strong focus on the re-orienting the health system as a whole, including the importance of engaging community and patient groups. ASSIST principles of people-centeredness are complementary to the WHO strategy, particularly with respect to coordination and continuity of care, information, and the micro-level interactions between a client and the health care service delivery team that promote or hinder people-centeredness.

The objective of the prevention of Mother-to-Child Transmission (pMTCT) cascade analysis tool is to
provide frontline health managers at the facility level with the means to rapidly, independently and quantitatively
track patient flows through the pMTCT cascade, and readily identify priority areas for clinic-level improvement
interventions. [from abstract]

This study measures service quality management in a private hospital in Gauteng, South Africa. This was done by
determining the current standard of service quality management, identifying the gap between the value and the satisfaction of the service quality dimensions, as well as the influence of gender on the perception of service quality. [from abstract]

Definitions of fragile states focus on state willingness and capacity to ensure security and provide essential
services, including health. Conventional analyses and subsequent policies that focus on state-delivered essential services miss many developments in severely disrupted healthcare arenas. The research seeks to gain insights about the large sections of the health field left to evolve spontaneously by the absent or diminished state. ]from abstract]

Quality of care can be significantly improved by engaging teams of frontline workers to identify problems and find local solutions for those problems. Based on the results achieved in Kunduz, Balkh, and Kabul, the collaborative improvement work was expanded from 2010–2012 to seven more provinces. The results achieved on the ground also led the MoPH to establish a unit for quality and a national health care quality improvement strategy for Afghanistan. [from abstract]

A new approach to the measurement of service delivery is introduced. The Service Delivery Underperformance Index (SDUI)
adapts the Alkire and Foster (2011) methodology used for poverty measurement to measure the underperformance, or multiple inadequacies, in service delivery. [from abstract]

Health care workers are exposed to different kinds of occupational hazards due to their day to day activities. The most common occupational exposure like body fluids are a potential risk of transmission of blood born infection like human immunodeficiency virus. [from abstract]

The world is witnessing the unprecedented unfolding of the West African Ebola epidemic. The epidemic could have major ramifications for global public health in ways that no other modern infectious disease has, perhaps including AIDS, and can be viewed as a “Black Swan” event. What we call here a Black Swan (and capitalize it) is an event with the following three attributes. First, it is an outlier, as it lies outside the realm of regular expecta- tions, because nothing in the past can convincingly point to its possibility.

The study observed the impact of an experimental supportive intervention to India’s malaria control program by location on the individual level. There are various possible reasons that account for the observed divergence across districts. [from abstract]

The goals of Universal Health Coverage (UHC) are to ensure that all people can access quality health services, to safeguard all people from public health risks, and to protect all people from impoverishment due to illness, whether from out-of-pocket payments for health care or loss of income when a household member falls sick. [from resource]

Performance-Based Financing (PBF) has been advanced as a solution to contribute to improving the performance of health systems in developing countries. This is the case in Benin. This study aims to analyse how two PBF approaches, piloted in Benin, behave during implementation and what effects they produce, through investigating how local stakeholders perceive the introduction of PBF, how they adapt the different approaches during implementation, and the behavioural interactions induced by PBF. [from abstract]

In the 20 years since South Africa underwent a peaceful transition from apartheid to a constitutional democracy, considerable social progress has been made toward reversing the discriminatory practices that pervaded all aspects of life before 1994.1-5 Yet the health and well-being of most South Africans remain plagued by a relentless burden of infectious and noncommunicable diseases, persisting social disparities, and inadequate human resources to provide care for a growing population with a rising tide of refugees and economic migrants. [from abstract]

The development of comprehensive community based health information systems is increasingly becoming important for measuring and improving the quality of health services. Many developing countries including Kenya have made efforts to strengthen their national health information systems to provide information
for decision-making in managing health care services. The purpose of this paper is to explore how data collected at the community level is utilised by various stakeholders within the community in order to produce actionable information for decision making. [from abstract]

Qualified and motivated human resource (HR) is essential for a qualitative and robust health care delivery. Understanding the constraints and difficulties of health managers is essential for effective and efficient management of health care services. The present study is aimed at understanding the various constraints and difficulties of human resource management (HRM) in the public health sector. [from abstract]

In the last decade, evidence has emerged that user fees are regressive and undermine equitable access to essential health services, particularly for women and children. It is against this background that the government of Kenya took decisive action to remove user fees in dispensaries and health centers and to provide free maternal health services at all public health facilities in an effort to increase access to essential health services and reduce maternal mortality. [adopted from introduction]

Community-based monitoring and planning (CBMP) of health services in Maharashtra state, India represents an innovative participatory approach to improving accountability and healthcare delivery. This paper examines the successes and challenges of this process, discussing lessons learned and the potential for generalizing such initiatives to other sectors and regions. Maharashtra’s experiment could inform ‘communitization’ of health services in diverse contexts, as an alternative to
privatization and as a means to enhancing the ‘publicness’ of health services. [from summary]

Evidence-based behavior change interventions addressing health systems must be identified and disseminated to improve child health outcomes. Studies of the efficacy of such interventions were identified from systematic searches of the published literature. Two hundred twenty-nine of the initially identified references were judged to be relevant and were further reviewed for the quality and strength of the evidence.

Interactions between patients and service providers frequently influence uptake of prevention of mother-to-child
transmission (PMTCT) HIV services in sub-Saharan Africa, but this process has not been examined in depth. [from abstract]

Quality of care plays an important role in the status of tuberculosis (TB) control, by influencing timely diagnosis, treatment adherence,and treatment completion. In this study,we aimed at establishing the quality of TB service care in Kamuli district health care centres using Donabedian structure, process, and outcomes model of health care. One of the worst performance indicators was low percentage of cure.

Implicit rationing of nursing care is the withholding of or failure to carry out all necessary nursing measures due to lack of resources. There is evidence supporting a link between rationing of nursing care, nurses’ perceptions of their professional environment, negative patient outcomes, and placing patient safety at risk. [from abstract]