SSM - Health Systems最新文献

{"title":"The COVID-19 pandemic: A focusing event to promote domestic investment for health systems strengthening in the WHO African Region","authors":"Alison T. Mhazo ,&nbsp;Arush Lal ,&nbsp;Elias Mossialos","doi":"10.1016/j.ssmhs.2024.100034","DOIUrl":"10.1016/j.ssmhs.2024.100034","url":null,"abstract":"<div><h3>Background</h3><div>The COVID-19 pandemic has been framed as a catalytic occurrence that exposed the chronic underinvestment in health systems strengthening (HSS) in the WHO African Region as well as its potential to galvanize much-needed political attention towards the issue. This expectation aligns with the portrayal of COVID-19 as a ‘focusing event’ for HSS. This study analyzes whether COVID-19 met the criteria of a focusing event for HSS as set forth by John Kingdon, and then, if as a focusing event, it generated political attention towards policy making and implementation for HSS and whether there could be prospects for sustaining such momentum in the post COVID-19 era.</div></div><div><h3>Methods</h3><div>We carried out a scoping review of available literature using the O’Malley and Arksey method (2005).</div></div><div><h3>Results</h3><div>The COVID-19 pandemic presented an unprecedented crisis that drew attention to the problem of weak health systems in the WHO African region, a problem that had long been acknowledged but largely ignored. This study has also shown that COVID-19 had a profound personal experience on policy makers since it severely limited their opportunity to seek medical care abroad and forced them to personally witness the weak state of domestic health systems. These attributes suit the criteria of COVID-19 as a focusing event according to Kingdon, which helped to stimulate governmental action on HSS.</div></div><div><h3>Conclusion</h3><div>The COVID-19 pandemic can indeed be leveraged as a salient focusing event to generate political attention for HSS in the WHO African Region. However, such attention cannot be guaranteed in the long-term, due to the differential dynamics between policy making and implementation in crises and non-crisis situations. By casting light on a plausible but rarely examined mechanism for driving policy change –the personal experience of policy makers, we conclude that lack of financial resources does not sufficiently explain the lack of domestic investments for HSS. This calls for attention towards other reasons of inaction towards HSS, including the insulation of the elite from facing the weak health systems.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100034"},"PeriodicalIF":0.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supply-side factors influencing national health insurance uptake, access and use of primary health care: Evidence from the Upper West Region, Ghana","authors":"Justine Guguneni Tuolong ,&nbsp;Kennedy A. Alatinga ,&nbsp;Elijah Yendaw","doi":"10.1016/j.ssmhs.2024.100036","DOIUrl":"10.1016/j.ssmhs.2024.100036","url":null,"abstract":"<div><div>Supply-side factors, such as the availability of health facilities, equipment, practitioners, and drugs, are crucial for improving global healthcare systems. However, systematic evidence of how these factors affect health insurance clients’ access to primary healthcare (PHC) services in Ghana is lacking. This study addresses this gap by examining the impact of these factors on insured individuals' access to PHC services in Wa Municipality. An explanatory sequential mixed-methods design was employed, involving a quantitative survey of 413 insured individuals randomly selected from 40 communities and 47 healthcare facilities. Purposive sampling was used for qualitative interviews with 17 healthcare providers and 20 key insured informants. Quantitative data were analysed using descriptive statistics, correlation, independent t-tests, and binary logistic regression, while qualitative data were thematically analysed to provide insight into the quantitative findings. Result from quantitative data showed that Community-Based Health Planning and Services (CHPS) were more accessible than hospitals, diagnostic centres, and health centres. Proximity to health facilities influenced access to PHC services and National Health Insurance Scheme (NHIS) uptake. Perceived availability and functionality of healthcare equipment also affected NHIS uptake. Qualitatively, health facilities reported a shortage of human resources, such as midwives and nurses, for PHC service delivery. Triangulating quantitative and qualitative results show that healthcare supplies and skilled professionals are essential for NHIS uptake and access to PHC services. This study recommends that Government of Ghana prioritise expanding healthcare facilities, recruiting and retaining skilled practitioners, procuring medical equipment, and equitably distributing essential medications to improve access to essential healthcare services in underserved areas.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100036"},"PeriodicalIF":0.0,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142425554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of Ghana’s national health insurance exemption policies on healthcare-seeking behaviour","authors":"Yaw Boateng Atakorah ,&nbsp;Eric Arthur ,&nbsp;Anthony Kofi Osei-Fosu ,&nbsp;Jacob Novignon","doi":"10.1016/j.ssmhs.2024.100035","DOIUrl":"10.1016/j.ssmhs.2024.100035","url":null,"abstract":"<div><div>Countries all over the world are seeking to enhance the general well-being of their populations by instituting a prepayment health system in which people can access healthcare at any time without financial risks. In Ghana, the National Health Insurance Scheme (NHIS) seeks to achieve this objective while leaving no one behind. To accelerate the country’s UHC agenda, the scheme was designed to also provide premium exemptions to the poor and vulnerable. While the exemption policy removes financial barriers to both subscription and healthcare, its impact on health-seeking is unknown. This study, therefore, sought to evaluate the impact of the premium exemption policies on healthcare-seeking behaviours. Data from the most recent round of the Ghana Living Standards Survey (GLSS 7) was used. A total sample of 8297 individuals were included in the analysis comprising 5686 rural and 2611 urban dwellers. We used the Lewbel instrumental variable technique to correct potential endogeneity problems. We found that NHIS exemption policies improved both general and formal healthcare-seeking. For general healthcare-seeking, the impact was driven by individuals exempted through under 18 and aged category. However, focusing on formal care, both exemption through under 18 or aged category as well as through indigents or Free Maternal Services category both improved healthcare-seeking. The magnitude of the impact was also greater for categories that were fully exempted and did not require any form of payment to subscribe. The findings call for a policy review to differentially target individuals living in areas with different economic and health system realities.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100035"},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142425552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjusting for quality of care in primary health care utilization and benefits in Bihar, India: A benefit incidence analysis","authors":"Akriti Mehta ,&nbsp;Bryan N. Patenaude,&nbsp;Krishna D. Rao","doi":"10.1016/j.ssmhs.2024.100033","DOIUrl":"10.1016/j.ssmhs.2024.100033","url":null,"abstract":"<div><div>India’s public health policies prioritize the least wealthy and vulnerable. Additionally, for Primary Health Care (PHC) to achieve equitable health outcomes, all must receive high-quality care. This study determined equality of utilization and benefit incidence of PHC services across socioeconomic (SE) groups in Bihar, with and without adjusting for quality of care. It used secondary data from linked PHC facility and household surveys in Bihar that included information on PHC facility utilization, quality of care and household expenditure patterns. Lorenz curves and concentration indices were constructed to examine relative distribution of utilization and benefits from public sector PHC services by SE status, before and after adjusting for quality of care using quality weights. We found that relative distribution of public sector PHC utilization, total and net benefits was statistically no different from perfect equality. With quality weights, utilization and benefits of PHC facilities in Bihar were slightly more pro-rich but statistically no different from perfect equality. The wealthiest do not disproportionately benefit from public sector PHC facilities, but neither do the least wealthy. In conclusion, relative utilization and benefits of public sector PHC facilities were equally distributed across socioeconomic groups in Bihar. Benefits from public sector PHC facilities are not disproportionately concentrated among the least wealthy in the community. As the Ayushman-Bharat Health and Wellness Centers are strengthened to improve public sector PHC services, it would be important to target its benefits towards the least wealthy by ensuring services are accessible and amenable.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100033"},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“We do these audits, but in the end, it’s useless.” How can facility-based maternal death reviews improve the quality of care in Benin?","authors":"Christelle Boyi Hounsou ,&nbsp;Jean-Paul Dossou ,&nbsp;Thérèse Delvaux ,&nbsp;Lenka Benova ,&nbsp;Edgard-Marius Ouendo ,&nbsp;Sorel Lokossou ,&nbsp;Marjolein Zweekhorst ,&nbsp;Bruno Marchal","doi":"10.1016/j.ssmhs.2024.100032","DOIUrl":"10.1016/j.ssmhs.2024.100032","url":null,"abstract":"<div><div>Benin scaled up facility-based Maternal Death Reviewss (MDRs) in 2013 to address its high maternal mortality rate. This study aims to assess the extent to which facilitybased MDR captured the complex causes of maternal deaths in 2022. In this mixedmethod study, we first conducted a quantitative analysis of dysfunctions, root causes,and recommendations extracted from all facility-based MDR reports that occurred in Benin's health facilities in 2022. We calculated frequency distributions based on the systemic maternal care quality assessment framework's components and the iceberg model for system thinking's layers. Second, we conducted in-depth and informal interviews and (non)participant observations and reviewed facility-based MDR policyrelated documents. Content analysis was applied to qualitative data. facility-based MDR teams identified 1295 dysfunctions, 1216 root causes, and 1082 recommendations in facility-based MDR reports of 540 maternal deaths. One-fifth of reports were uninformative, lacking dysfunctions, root causes, or recommendations.Within the health system components, leadership and governance received the least attention regarding dysfunctions (1 %) and root causes (12 %).Most dysfunctions (87 %) and root causes (73 %) focused on the iceberg's tip, leading to reactive recommendations rather than addressing deeper systemic issues. Two main factors emerged: non-compliance with facility-based MDR requirements (time constraints, unreliable data, fear of strained provider relationships) and limitations in facility-based MDR processes (data collection and analysis tool constraints),</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100032"},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management outcome of incomplete abortion and its associated factors in Northwest Ethiopia: A health facility based cross-sectional study","authors":"Simegnew Asmer Getie ,&nbsp;Getahun Tadele ,&nbsp;Habtamu Gebrehana Belay ,&nbsp;Natnael Dechasa Gemeda ,&nbsp;Fentahun Alemnew Chekole ,&nbsp;Wondu Feyisa Balcha","doi":"10.1016/j.ssmhs.2024.100031","DOIUrl":"10.1016/j.ssmhs.2024.100031","url":null,"abstract":"<div><h3>Background</h3><div>Incomplete abortion can be managed medically or surgically at a health facility by trained healthcare providers. However, women develop unfavorable management outcomes of incomplete abortion following initial management.</div></div><div><h3>Objective</h3><div>This study aimed to assess the management outcome of incomplete abortion and its associated factors at Injibara General Hospital, Northwest Ethiopia.</div></div><div><h3>Methods</h3><div>A health facility-based retrospective cross-sectional design was conducted from May 1/2018 to April 30/2020. A medical record review of 260 women who received abortion service was done and 236 cases managed for incomplete abortion were included in the study with a response rate of 90.8 %. Logistic regression analyses were employed to estimate the crude and adjusted odds ratio with a confidence interval of 95 % and a P-value of less than 0.05 considered statistically significant.</div></div><div><h3>Results</h3><div>The findings of this study showed that 12.3 % of the women developed unfavorable management outcomes of incomplete abortion. Women who are found in the age group of 15–25 years, gestational age <u>&gt;</u>13 weeks, seek care after 24 hours of the onset of symptoms, and medical management of the incomplete abortion were associated with unfavorable management outcomes of incomplete abortion.</div></div><div><h3>Conclusion</h3><div>Considering its effect on maternal health, this study showed that the unfavorable management outcome of incomplete abortion was higher. Women's age, gestational age, the timing of seeking care, and method of management were associated with unfavorable management outcomes of incomplete abortion. Therefore, it is necessary to counsel women on the danger signs of early pregnancy and the advantages of early care-seeking.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100031"},"PeriodicalIF":0.0,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142323364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Core components of infectious disease outbreak response","authors":"Mackenzie Moore ,&nbsp;Hailey Robertson ,&nbsp;David Rosado ,&nbsp;Ellie Graeden ,&nbsp;Colin J. Carlson ,&nbsp;Rebecca Katz","doi":"10.1016/j.ssmhs.2024.100030","DOIUrl":"10.1016/j.ssmhs.2024.100030","url":null,"abstract":"<div><div>Outbreak response, as a technical and specialized field of practice, is struggling to keep pace with the evolving landscape of public health emergencies. Here, we analyze 235 different multisectoral activities that comprise outbreak preparedness and response. We explore the conditions under which these activities are applicable, including different phases of response, different operating circumstances, and different disease etiologies, and find that the core activities required for outbreak response largely apply across etiology and scale, but are more substantial during the early phases of response. To validate this framework with real-world examples, we then examine 246 reports from the WHO Disease Outbreak News (DON), a narrative record of outbreak history through time, and examine which of our activities are reported or implied in these narratives. We find that the core components of response are applicable across the vast majority of outbreaks, especially as they relate to basic epidemiology, infection prevention, and governance, and that many different kinds of real-world outbreaks require the same core set of responses. These findings point to a nearly-universal set of outbreak response activities that could be directly incorporated into national and international response plans, significantly reducing the risk and impact of infectious disease outbreaks.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100030"},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000230/pdfft?md5=1ef813f44a8d3c83beebfd277f84e81e&pid=1-s2.0-S2949856224000230-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142312753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of personal social networks in supporting patients with chronic diseases to access outpatient clinics in Mbeya, Tanzania: A mixed methods study","authors":"Brady Hooley ,&nbsp;Grace Mhalu ,&nbsp;Sally Mtenga ,&nbsp;Fabrizio Tediosi","doi":"10.1016/j.ssmhs.2024.100029","DOIUrl":"10.1016/j.ssmhs.2024.100029","url":null,"abstract":"<div><p>The increasing prevalence of non-communicable diseases (NCDs) in Tanzania and the inequitable provision of NCD care drives patients to seek support from their social networks. We studied a sample of patients with NCDs attending outpatient clinics to understand how informal social support helps patients with NCDs in coping with their illness, and whether it is associated with patients’ engagement in care. We used mixed methods to analyse data from a client exit survey implemented in outpatient clinics in Mbeya, Tanzania in 2022. The quantitative analyses of data on 108 patients was complemented by qualitative analysis of in-depth interviews conducted on a sub-sample of 30 participants. Most patients faced difficulties completing work and household activities, creating a need for financial support. Expectations of reciprocal intergenerational support led patients’ children to be the dominant providers of financial support. Participants’ social ties frequently provided financial support, while emotional and informational support were provided to a lesser extent. Informal social support fills gaps in social health protection schemes and promotes engagement in care by providing patients with the means to finance uninsured costs of care. Expanding old age social security or other resource pooling mechanisms could reduce the susceptibility of patients and their support networks to catastrophic health expenditure, even for those with health insurance.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100029"},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000229/pdfft?md5=d1e8f3b48bd2f0d9fd14b3134bfb1a02&pid=1-s2.0-S2949856224000229-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142168267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unmet need and access to family physicians: A national analysis using the Canadian Longitudinal Study on Aging","authors":"Feben W. Alemu ,&nbsp;Kathryn Nicholson ,&nbsp;Piotr Wilk ,&nbsp;Jane S. Thornton ,&nbsp;Shehzad Ali","doi":"10.1016/j.ssmhs.2024.100028","DOIUrl":"10.1016/j.ssmhs.2024.100028","url":null,"abstract":"<div><h3>Background</h3><p>The Canadian health care system was founded on the principle of universal access to care. However, recent reports have ranked the country among the lowest performing high-income health systems in terms of access to care and health equity. This study investigates the determinants of access to care in older Canadian adults using a nationally representative survey.</p></div><div><h3>Methods</h3><p>This cross-sectional study used data from the Canadian Longitudinal Study of Aging (N = 41,135) to examine the determinants of two indicators of healthcare access: self-reported access to a family physician and unmet need of care. Multivariable logistic regression models were used to evaluate the association between these indicators and sociodemographic determinants.</p></div><div><h3>Results</h3><p>Approximately 1 in 30 of the survey participants (aged ≥ 45 years at baseline) did not have a family physician, and 8 % reported having unmet need for healthcare. The odds of having a family physician were higher among individuals who were older (≥ 55 years), female, had higher income (≥$100,000), poorer perceived mental health, or had ≥1 chronic condition. The odds of reporting unmet need were higher for individuals who were younger (45–54 years), female, non-white, had lower income (&lt;$50,000), poorer perceived health status and had ≥2 chronic conditions.</p></div><div><h3>Conclusions</h3><p>Despite progress over recent years, access to healthcare remains a challenge for older Canadians, particularly those who are socially disadvantaged. Tailored policy interventions are needed to reduce unmet need in the aging Canadian population.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100028"},"PeriodicalIF":0.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000217/pdfft?md5=af1019a30297fe12737085d8f52415b3&pid=1-s2.0-S2949856224000217-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142164578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resilience in interconnected community and formal health (and connected) systems","authors":"Matt Fortnam ,&nbsp;Peter Hailey ,&nbsp;Sophie Witter ,&nbsp;Nancy Balfour","doi":"10.1016/j.ssmhs.2024.100027","DOIUrl":"10.1016/j.ssmhs.2024.100027","url":null,"abstract":"<div><div>Enhancing the resilience of health systems to expected and unexpected shocks – from COVID-19 to the health impacts of climate change – is becoming a defining challenge of this century worldwide. To date, health system resilience research has focused on formal government health systems, yet emerging evidence points to the importance of families, communities and connected systems (such as disaster management, water, sanitation, social protection and gender disparities) that influence the health status of people, and health system functioning and capacities to respond to shocks. We argue that resilience capacities in both formal and community health systems, and connected systems, be considered in health system resilience conceptual frameworks, and that well-established literature on community resilience capacities from diverse disciplines can help frame research on community health system resilience.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100027"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142425556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}