Service Delivery

Prior to implementing male circumcision as a public health measure against the spread of HIV, the feasibility, safety and costs of the procedure within target countries should be evaluated to understand what measures need to be taken to ensure access to safe, affordable voluntary circumcision services. The aims of this study were to assess variation and safety of male circumcision practices, as well as resource and training needs related to the procedure, in a community that has been practicing circumcision traditionally for many generations. [from introduction]

Most children undergoing surgery in Kenya are anaesthetised by clinical officers or anaesthetists with minimal training in paediatric anaesthesia. This article details the statistics of how this personnel shortage impacts anaesthesia delivery. [from introduction]

In South Africa, first-contact primary care is delivered by nurses in small clinics and larger community health centres (CHC). CHCs also employ doctors, who often work in isolation from the nurses, with poor differentiation of roles and little effective teamwork or communication. Worcester CHC, a typical public sector CHC in rural South Africa, decided to explore how to create more successful practice teams of doctors and nurses.

This case study evaluates a project in Kenya that concentrates on HIV and AIDS care and prevention through support and training of community volunteers to provide PLHA with HBC, widespread and diverse efforts to promote behavior change and raise awareness about HIV and AIDS, improving access to VCT, as well as capacity building efforts and direct material assistance for OVC and PLHA. [adapted from introduction]

A study of private-sector immunization services was undertaken to assess scope of practice and quality of care and to identify opportunities for the development of models of collaboration between the public and the private health sector. A questionnaire survey was conducted with health providers at 127 private facili¬ties; clinical practices were directly observed; and a policy forum was held for government representatives, private healthcare providers, and international partners. [from abstract]

The community score card process is a community-based monitoring tool that is a hybrid of the techniques of social audits and citizen report cards.The CSC is an instrument to exact social and public accountability and responsiveness from service providers. By linking service providers to the community, citizens are empowered to provide immediate feedback to service providers. [from author]

This report documents the assessment of a family planning training program for providers to enable them to offer family planning counseling and methods, and make referrals where needed as part of antiretroviral therapy services in Ghana. [from summary]

This brief is a best practice model for improving the quality and accessibility of family planning and HIV services in rural communities in Zimbabwe. [from author]

This presentation from the Scaling Up High-Impact FP/MNCH Best Practices in Asia and the Near East Technical Meeting covers the reasons to support integrated services and the challenges to this process.

Improving service delivery for the poor is an important way to help the poor lift themselves out of poverty. This resource presents and evaluates tools and techniques to measure service delivery and increase quality in health and education.

This article outlines the challenges facing the surgical workforce in Africa. Funding priorities in Africa typically favor infectious diseases, and surgery and perioperative care have been neglected, even though essential surgical care at district hospitals is more cost effective than some other highly prioritized interventions, such as antiretroviral therapy for HIV. There is a need to integrate surgical and anesthetic training programs so health personnel, particularly in rural areas, can treat the full range of diseases appropriate to that level of care. [adapted from author]

In an initiative to collate experiences on management development in low resource settings, WHO carried out case studies to explore management development approaches and how these impacted managerial and service delivery performance. [adapted from author]

This research study was undertaken to test the feasibility, acceptability, and effectiveness of two models of integrating family planning services with postabortion services.

Little is known about the impact of implementing nursing-oriented best practice guidelines on the delivery of patient care in either hospital or community settings. The results of this study indicate that implementation of nursing best practice guidelines can result in improved practice and patient outcomes in some settings. [adapted from author]

Providing contraceptive services at VCT centers is an opportunity to prevent unintended pregnancies among clients whose needs may not be met through traditional family planning services. Operations research in Kenya suggests that integrating family planning into VCT services is feasible and acceptable. An integration intervention improved providers’ discussions about fertility desires and contraceptive methods with clients, without compromising the length of client-provider interaction or client waiting time.

The report aims to share findings from an assessment to explore how access to critical services for populations at risk of HIV and unintended pregnancy can be strengthened by converging HIV and sexual and reproductive health (SRH) services under the National Rural Health Mission (NRHM) and the National Aids Control Programme (NACP). The report provides information on the demand and opportunities for and the challenges of implementing HIV and SRH convergence in four states

Despite the usefulness of voluntary counselling and testing centres implemented in Africa, their limited capacity does not allow for vast testing of the general population. Therefore, in order to increase the number of individuals tested for HIV with the aim of enhancing the scaling up, we developed a strategy based on bringing the healthcare package much closer to the people, by using mobile HIV testing units. We herein report the Cameroon experience of mobile HIV testing unit strategy, demonstrating its effectiveness in reaching a great number of individuals, including those without usual access to HIV testing facilities. [abstract]

The main objectives of this study were to assess the quality of the written communication between physicians and to estimate the number of patients that could have been treated at primary care level instead of at a general hospital. [from abstract]

This document focuses on FP integration with HIV services, more specifically with HIV care and treatment services. It encourages supervisors or planners, service providers, and community-based personnel to consider opportunities for operationalizing client-responsive integration of FP and HIV services.

As strides are made in the prevention and treatment of HIV, it is important to take advantage of opportunities to expand and integrate reproductive health services. Integration is an approach that uses a client visit as an opportunity to address other health and social needs beyond those that prompted the current health visit.

This working paper evaluates th success of the Quality of Care Management Center in Nepal and highlights the fact that even in resource-poor settings, quality of care in health service delivery can be achieved. This model for a quality of care center that provides timely, appropriate, and ongoing support to clinical facilities may be especially useful in countries where centralized systems are in place for allocation of resources or where maintenance and supply capacity is limited to central locations.

Increasing evidence supporting the value of screening women for cervical cancer once in their lifetime, coupled with mounting interest in scaling up successful screening demonstration projects, present challenges to public health decision makers seeking to take full advantage of the single-visit opportunity to provide additional services.

This presentation details a program to implement and evaluate the feasibility, acceptability, effectiveness and cost of two models of integration of HIV prevention information, and routine offer of provider initiated counselling and testing for HIV into family planning (FP) services in 18 health facilities in North West Province, South Africa. [adapted from abstract]

To maximize program impact with current resources, integration of Family Planning into existing HIV/AIDS programs is a very cost effective and an excellent point of entry. This is a study of an intervention program focused on initiating and also strengthening existing integration of FP into functional VCT, ART and PMTCT sites. The intervention encompassed an orientation on integration benefits to heads of health facilities; identification of challenges of integration and drawing of plan of action on how to overcome the challenges and improve integration.

In Albania, the PHRplus Project developed and tested a series of tools designed to introduce family medicine concepts and strengthen primary health care (PHC) services. PHC facility managers will find the toolkits useful reference materials when developing strategies and tools to improve quality of care and monitor and evaluate PHC strengthening efforts. This series comprises three toolkits: PHC Service Delivery Toolkit; PHC Quality Improvement (QI) Toolkit; and PHC Health Information Systems (HIS) Toolkit. [from abstract]

This case study describes how five Integrated Management of Childhood Illness (IMCI) trainers and supervisors conducted an assessment of provider knowledge and skill to carry out IMCI at 38 facilities in two districts in Kenya. [author’s description]

This handbook is intended to help bridge the gap between the theoretical constructs behind mentoring (and associated cultural change in health-care settings) and real practitioner experience. Although mentoring has taken hold in a variety of professional settings, we focus specifically upon mentoring for service-delivery change within clinical health-care settings. Our audience is likely to be a practitioner who sees the need for a new process, protocol or procedure.

Since 1994, Brazil has developed a primary care system based on multidisciplinary teams which include not only a physician and a nurse, but also 4-6 lay community health workers. Yet relatively few investigations have examined its effectiveness, especially in contrast with that of the traditional multi-specialty physician team approach it is replacing, or that of other existing family medicine approaches placing less emphasis on lay community health workers. The main objective of the study is to evaluate the quality of care offered to adults through different models of care currently present.

The purpose of this study is to estimate the cost implications of implementing the newly proposed Integrated Management of Childhood Illnesses algorithm in first-level health care facilities in rural areas of Bangladesh. Bangladesh policymakers need to know the cost of IMCI prior to its implementation so that they allocate adequate resources, particularly personnel and drugs, and the associated financial resources to health facilities. [from author]

Dissatisfied with centralized approaches to delivering local public services, a large number of countries are decentralizing responsibility for these services to lower- level, locally elected governments. The results have been mixed. This chapter provides a framework for evaluating the benefits and costs, in terms of service delivery, of different approaches to decentralization, based on relationships of accountability between different actors in the delivery chain. Moving from a model of central provision to that of decentralization to local governments introduces a new relationship of accountability—between national and local policymakers—while altering existing relationships, such as that between citizens and elected politicians.