SSM - Health Systems最新文献_第6页

Adjusting for quality of care in primary health care utilization and benefits in Bihar, India: A benefit incidence analysis 调整印度比哈尔邦初级保健利用率和收益中的保健质量：受益发生率分析

SSM - Health Systems Pub Date : 2024-09-25 DOI: 10.1016/j.ssmhs.2024.100033

Akriti Mehta , Bryan N. Patenaude, Krishna D. Rao

{"title":"Adjusting for quality of care in primary health care utilization and benefits in Bihar, India: A benefit incidence analysis","authors":"Akriti Mehta , Bryan N. Patenaude, 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}

引用次数: 0

“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? "我们做了这些审核，但最终都是无用功"。以医疗机构为基础的孕产妇死亡评审如何提高贝宁的医疗质量？

SSM - Health Systems Pub Date : 2024-09-24 DOI: 10.1016/j.ssmhs.2024.100032

Christelle Boyi Hounsou , Jean-Paul Dossou , Thérèse Delvaux , Lenka Benova , Edgard-Marius Ouendo , Sorel Lokossou , Marjolein Zweekhorst , Bruno Marchal

{"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 , Jean-Paul Dossou , Thérèse Delvaux , Lenka Benova , Edgard-Marius Ouendo , Sorel Lokossou , Marjolein Zweekhorst , 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}

引用次数: 0

Management outcome of incomplete abortion and its associated factors in Northwest Ethiopia: A health facility based cross-sectional study 埃塞俄比亚西北部不完全流产的管理结果及其相关因素：基于医疗机构的横断面研究

SSM - Health Systems Pub Date : 2024-09-21 DOI: 10.1016/j.ssmhs.2024.100031

Simegnew Asmer Getie , Getahun Tadele , Habtamu Gebrehana Belay , Natnael Dechasa Gemeda , Fentahun Alemnew Chekole , Wondu Feyisa Balcha

{"title":"Management outcome of incomplete abortion and its associated factors in Northwest Ethiopia: A health facility based cross-sectional study","authors":"Simegnew Asmer Getie , Getahun Tadele , Habtamu Gebrehana Belay , Natnael Dechasa Gemeda , Fentahun Alemnew Chekole , 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>></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}

引用次数: 0

Core components of infectious disease outbreak response 应对传染病爆发的核心内容

SSM - Health Systems Pub Date : 2024-09-12 DOI: 10.1016/j.ssmhs.2024.100030

Mackenzie Moore , Hailey Robertson , David Rosado , Ellie Graeden , Colin J. Carlson , Rebecca Katz

{"title":"Core components of infectious disease outbreak response","authors":"Mackenzie Moore , Hailey Robertson , David Rosado , Ellie Graeden , Colin J. Carlson , 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}

引用次数: 0

The role of personal social networks in supporting patients with chronic diseases to access outpatient clinics in Mbeya, Tanzania: A mixed methods study 在坦桑尼亚姆贝亚，个人社交网络在支持慢性病患者前往门诊就医方面的作用：混合方法研究

SSM - Health Systems Pub Date : 2024-09-06 DOI: 10.1016/j.ssmhs.2024.100029

Brady Hooley , Grace Mhalu , Sally Mtenga , Fabrizio Tediosi

{"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 , Grace Mhalu , Sally Mtenga , 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}

引用次数: 0

Unmet need and access to family physicians: A national analysis using the Canadian Longitudinal Study on Aging 未满足的需求和获得家庭医生服务的机会：利用加拿大老龄问题纵向研究进行的全国性分析

SSM - Health Systems Pub Date : 2024-09-02 DOI: 10.1016/j.ssmhs.2024.100028

Feben W. Alemu , Kathryn Nicholson , Piotr Wilk , Jane S. Thornton , Shehzad Ali

{"title":"Unmet need and access to family physicians: A national analysis using the Canadian Longitudinal Study on Aging","authors":"Feben W. Alemu , Kathryn Nicholson , Piotr Wilk , Jane S. Thornton , 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 (<$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}

引用次数: 0

Resilience in interconnected community and formal health (and connected) systems 相互关联的社区和正规卫生（及关联）系统的复原力

SSM - Health Systems Pub Date : 2024-09-01 DOI: 10.1016/j.ssmhs.2024.100027

Matt Fortnam , Peter Hailey , Sophie Witter , Nancy Balfour

引用次数: 0

Hidden in plain sight: Validating theory on how health systems enable the persistence of women’s mistreatment in childbirth through a case in Tanzania 隐藏在众目睽睽之下：通过坦桑尼亚的一个案例验证关于医疗系统如何使妇女在分娩时持续遭受虐待的理论

SSM - Health Systems Pub Date : 2024-08-25 DOI: 10.1016/j.ssmhs.2024.100026

Kate Ramsey , Irene Mashasi , Wema Moyo , Selemani Mbuyita , August Kuwawenaruwa , Stephanie A. Kujawski , Margaret E. Kruk , Lynn P. Freedman

{"title":"Hidden in plain sight: Validating theory on how health systems enable the persistence of women’s mistreatment in childbirth through a case in Tanzania","authors":"Kate Ramsey , Irene Mashasi , Wema Moyo , Selemani Mbuyita , August Kuwawenaruwa , Stephanie A. Kujawski , Margaret E. Kruk , Lynn P. Freedman","doi":"10.1016/j.ssmhs.2024.100026","DOIUrl":"10.1016/j.ssmhs.2024.100026","url":null,"abstract":"<div><div>Mistreatment in childbirth has been identified as a concerning pattern reproduced and normalized in health systems globally. To address mistreatment, social theory is required. Mistreatment as normalization of organizational deviance holds promise as a nascent theoretical framework but requires further validation. The theory posits that a health system distorted by resource scarcity and production pressures causes meso-level actors to seek workarounds and ration services. Emphasis on biomedicine leads providers to ration emotion work resulting in mistreatment. A qualitative theory-driven approach was applied to verify and expand nascent theory using qualitative data from a study in Tanzania. The data included eight focus group discussions and 37 in-depth interviews involving 91 individuals representing community and health system stakeholders. Data were analyzed deductively and inductively using the theory’s framework while allowing for new constructs. Participants’ perspectives largely supported key constructs within and relationships among the different levels of the system elaborated in the original theory. New elements that were identified included moral distress experienced by providers, managers coping with dual roles as managers and providers and the dynamics of women’s families in the service interaction. Greater detail on the regulatory environment showed challenges in monitoring mistreatment due to structural secrecy and the nature of mistreatment. Further theory testing in different contexts and types of health systems is needed. Advancing this theory and others will uncover the systemic factors enabling mistreatment towards solutions to ensure a respectful experience during childbirth for women and their newborns, and providers struggling in overburdened and under-resourced health systems.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100026"},"PeriodicalIF":0.0,"publicationDate":"2024-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142702054","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}

引用次数: 0

“I like it when you feel you can discuss things”: A qualitative study on sharing medical care for children with profound intellectual and multiple disabilities "我喜欢可以讨论事情的感觉"：关于为深度智力残疾和多重残疾儿童分担医疗护理的定性研究

SSM - Health Systems Pub Date : 2024-08-24 DOI: 10.1016/j.ssmhs.2024.100025

Liesbeth Geuze , Samuel Schrevel , Indigo van Houte , Anne Goossensen

{"title":"“I like it when you feel you can discuss things”: A qualitative study on sharing medical care for children with profound intellectual and multiple disabilities","authors":"Liesbeth Geuze , Samuel Schrevel , Indigo van Houte , Anne Goossensen","doi":"10.1016/j.ssmhs.2024.100025","DOIUrl":"10.1016/j.ssmhs.2024.100025","url":null,"abstract":"<div><p>In the Netherlands, many parents of children with profound intellectual and multiple disabilities care for their children at home. Little is known about how parents and involved healthcare professionals share and align medical care for these children. This study aims to contribute to a better understanding of the dimensions that affect how medical care is shared and how healthcare professionals can align care with family needs. The study design was inspired by grounded theory. We analyzed in-depth interviews with 25 Dutch parents. The analysis identified five dimensions affecting how parents and professionals shared and aligned medical care: fragility, planned care, irregularities, interactions with providers, and parents’ choices. We recognized three distinctive ways these dimensions interplayed, characterizing scenarios of sharing care: dependent care, dialogical care, and autonomous care. The findings illuminated that parental distress decreased when parents could communicate about what they considered important for their child and family and its implications for sharing care. Parents developed their capacity to manage medical care and often evolved in their thinking about the quality of care and life. Sometimes this evolution was due to struggles with the care provided by professionals. Therefore, healthcare professionals may need to broaden the relational work of shared decision-making to include the sharing of medical care. Arrangements need to be continually reassessed as changes in the child’s and family’s situation trigger changes in preferred patterns of sharing care. Commitment to parents’ autonomy implies that healthcare professionals should be attentive to the parents’ emotional and relational needs.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100025"},"PeriodicalIF":0.0,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000187/pdfft?md5=1be01d21bf0f949adc0eac5ae03e3ff2&pid=1-s2.0-S2949856224000187-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142098142","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}

引用次数: 0

Decentralizing care for hypertension and diabetes during the COVID-19 pandemic: Findings from mixed-methods implementation research in Eswatini COVID-19大流行期间分散高血压和糖尿病护理：来自斯瓦蒂尼混合方法实施研究的结果

SSM - Health Systems Pub Date : 2024-08-08 DOI: 10.1016/j.ssmhs.2024.100024

Christopher Pell , Nelisiwe Masilela , Phumile Hlatshwayo , Phiwayinkhosi Dlamini , Bongiwe Dlamini , Marjan Molemans , Nomathemba Nxumalo , Sakhile Masuku , Ria Reis , Fortunate Shabalala

{"title":"Decentralizing care for hypertension and diabetes during the COVID-19 pandemic: Findings from mixed-methods implementation research in Eswatini","authors":"Christopher Pell , Nelisiwe Masilela , Phumile Hlatshwayo , Phiwayinkhosi Dlamini , Bongiwe Dlamini , Marjan Molemans , Nomathemba Nxumalo , Sakhile Masuku , Ria Reis , Fortunate Shabalala","doi":"10.1016/j.ssmhs.2024.100024","DOIUrl":"10.1016/j.ssmhs.2024.100024","url":null,"abstract":"<div><div>In sub-Saharan Africa, non-communicable diseases (NCDs) are testing already-stretched health systems. In Eswatini, until 2020, care for hypertension and diabetes was only provided in tertiary health facilities. During the first phase of the COVID-19 pandemic, the Eswatini Ministry of Health expedited NCD care decentralization to primary facilities. Drawing on in-depth interviews, observations and a questionnaire-based survey, this article examines experiences of expedited NCD care decentralization. Respondents included people living with diabetes and/or hypertension (17 interviews and 248 survey respondents), nurses at primary care facilities (31 interviews) and programme managers (5 interviews). The interviews and observations indicated that the process of decentralization was initially uneven, blurred by the previous delivery of health promotion, incomplete training and the staggered nature of implementation. Reports of shortages in medicines and equipment were common and programme managers and health staff shared concerns about this undermining relationships with clients (and impacting treatment seeking). In primary facilities, NCD services were often delivered in an integrated way with consideration for co-morbidities. NCD clients expressed a strong preference for and overwhelmingly positive opinion of the decentralized services. Nonetheless, the identified challenges to delivering person-centred NCD care highlight the need to examine alternative service delivery models.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100024"},"PeriodicalIF":0.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578359","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}

引用次数: 0