BMC Health Services Research最新文献

{"title":"Facilitators and barriers of HIV pre-exposure prophylaxis use among four key populations in Iran.","authors":"Hossein Moameri, Parvin Mangolian Shahrbabaki, Fatemeh Tavakoli, Parya Saberi, Ali Mirzazadeh, Reza Goudarzi, Hamid Sharifi","doi":"10.1186/s12913-024-11933-w","DOIUrl":"https://doi.org/10.1186/s12913-024-11933-w","url":null,"abstract":"<p><strong>Background: </strong>Pre-exposure prophylaxis (PrEP) significantly reduces HIV transmission, but it is not commonly prescribed in Iran. Therefore, this study aimed to identify facilitators and barriers to PrEP use among four key populations (KPs) in Iran.</p><p><strong>Methods: </strong>We conducted in-depth qualitative interviews with female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), and sexual partners of people living with HIV (PLHIV) to obtain deep insights into the participants' experiences, beliefs, and viewpoints. We included HIV experts, including staff from the HIV control department, healthcare providers with HIV experience, health policymakers, infectious disease specialists, and university professors. We performed a content analysis to identify facilitators and barriers to PrEP implementation among KPs.</p><p><strong>Results: </strong>We interviewed seven FSW, seven MSM, four PWID, four sexual partners of PLHIV, and 18 HIV experts. The facilitator's theme emerged in four main categories, including eight different factors: 1) Individual and interpersonal factors (motivations, fear of testing positive for HIV, and safety nets and financial support), 2) Age and sex differences, 3) Organizational factors (appropriate PrEP distribution, information sharing, and receipt of high-quality services, 4) Efficacy of PrEP. The barrier's theme emerged in three main categories, including four factors: 1) Individual factors (insufficient knowledge and awareness, and fragile trust), 2) Cultural barriers, and 3) Organizational factors (inadequate infrastructure and organizational barriers).</p><p><strong>Conclusions: </strong>We identified key facilitators and barriers to successful PrEP implementation among KPs in Iran. By addressing these barriers, Iran has an opportunity to include PrEP programs in its HIV prevention efforts for KPs.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1433"},"PeriodicalIF":2.7,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinician attitudes towards adoption of evidence-based practice: a nationwide multiprofessional cross-sectional study of child and adolescent mental health services in Sweden.","authors":"Anna Helena Elisabeth Santesson, Robert Holmberg, Martin Bäckström, Peik Gustafsson, Håkan Jarbin, Sean Perrin","doi":"10.1186/s12913-024-11934-9","DOIUrl":"10.1186/s12913-024-11934-9","url":null,"abstract":"<p><strong>Background: </strong>Implementation of evidence-based practice (EBP) in child and adolescent mental health services (CAMHS) is a priority to improve service delivery and outcomes. Clinicians' EBP attitudes are likely to play a crucial role in implementation but are poorly understood. This study aimed to assess variation in EBP attitudes in a large national sample of CAMHS clinicians in Sweden, and to compare these findings to findings from the United States of America (USA).</p><p><strong>Methods: </strong>CAMHS clinicians (n = 799; 60% response rate) completed the Evidence-Based Practice Attitude Scale (EBPAS) and items from the Organizational Readiness for Change Scale (ORC) ahead of an EBP for depression implementation effort across Sweden. EBPAS scores were compared with the USA study. Predictors of global and specific attitudes (gender, age, working years, education, profession, perceived benefit of diagnosis and organizational readiness and type of service) were examined using simple and multiple linear regressions.</p><p><strong>Results: </strong>Clinicians had positive attitudes towards EBP on the four-dimensional subscales of the EBPAS, somewhat more so than their American counterparts. Clinician and organizational characteristics were related to at least one attitudinal dimension in both models, with perceived utility of diagnosis being the strongest and most consistent predictor across dimensions and models.</p><p><strong>Conclusions: </strong>Results from this large-scale national study underscore the need to consider cultural, contextual, and individual variations in attitudes towards EBP when planning implementation efforts. Such efforts may need to be tailored to the working contexts, needs, and values of CAMHS clinicians, particularly their views on the utility of diagnosis.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1432"},"PeriodicalIF":2.7,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regulation, modification, and evolution of remote sign language interpreting in Sweden - a service in progress.","authors":"Camilla Warnicke, Marie Matérne","doi":"10.1186/s12913-024-11907-y","DOIUrl":"10.1186/s12913-024-11907-y","url":null,"abstract":"<p><strong>Background: </strong>The sign language interpreting service has undergone a tremendous change due to COVID-19 and remote interpreting has become a more frequent alternative to the face-to-face format. The aim of the study is to investigate how the interpreters perceive the organisation of remote interpreting in Sweden and how it has evolved since the COVID-19 pandemic.</p><p><strong>Method: </strong>Interviews with 26 experienced remote interpreters, representing 19 of Sweden's 21 counties, were analysed with qualitative content analysis.</p><p><strong>Results: </strong>Three themes were revealed in the analysis. The first theme was regulation. It was stated that directives and regulatory decisions concerning provision of remote interpreting services were varied and unclear. Several different platforms were used when interpreting remotely. Some of the services had conducted risk analyses, whereas others had not. The second theme was modification, including adjusting interactions to suit the preferences and capabilities of the users (both signing and speaking parties), as well as adjustments to work environments and workplaces. The third theme, evolution of remote interpreting, showed that support and training were rare and varied. Although the processes and organisation of remote interpreting are not yet fully established in Sweden, remote interpreting is here to stay.</p><p><strong>Conclusions: </strong>In Sweden, remote interpreting is a service that varies according to regulations and the type of assignments. The service would benefit from being more uniform and streamlined across Sweden, although consideration must be given to those involved with the service.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1431"},"PeriodicalIF":2.7,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of encounters on patient app use: results of a tethered mobile personal health record usage pattern analysis.","authors":"Yae Won Tak, Jeong-Hoon Kim, Jae-Ho Lee, Yura Lee","doi":"10.1186/s12913-024-11881-5","DOIUrl":"10.1186/s12913-024-11881-5","url":null,"abstract":"<p><strong>Introduction: </strong>The adoption of tethered mobile personal health records provides not only medical information to patients but also various convenience functions related to hospital use, thereby increasing accessibility to healthcare services and promoting patient engagement. We analyse the tethered mobile personal health records app's usage logs to determine how it can contribute to improving medical service accessibility and patient engagement.</p><p><strong>Methods: </strong>Log data, that comprised menu type, log time, and date, were collected from the mobile personal health records app of a tertiary referral hospital. Clinical information, including patients' demographics and visit type, was collected from the clinical research warehouse system. The usage log was analysed in terms of the type of visit, service function, and time period.</p><p><strong>Results: </strong>Outpatients accounted for 34% of the total app usage and was the most app-accessed visit type. The most utilized menu functions were lab test and visit schedule for visits or non-visits. For Inpatient and Health check-ups, menu usage patterns showed a focus on lab test results. While investigations and other menu usage showed double peaks in the morning and afternoon, peak usage of lab test results correlated with inpatient blood sampling times, which was around 9 am.</p><p><strong>Discussion: </strong>App menus to access health information, particularly blood tests, emerged as the most accessed menu. Hence, when compared with blood sampling times and hospital information system usage patterns, encounters occurring in the hospital majorly impacted patient app use. For improved patient engagement, improving lab test function should be the priority.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1428"},"PeriodicalIF":2.7,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11572374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social innovation in access to healthcare: community-based health insurance among Senegalese migrants in Spain.","authors":"Modou Diop, Rita Sobczyk","doi":"10.1186/s12913-024-11926-9","DOIUrl":"10.1186/s12913-024-11926-9","url":null,"abstract":"<p><strong>Background: </strong>In several European Union countries, undocumented migrants face significant barriers to accessing universal healthcare. In Spain, Royal Decree-Law 16/2012 introduced restrictions that limited undocumented migrants' access to healthcare services, offering only emergency, maternal, and paediatric care. The implementation of this law created significant disparities in access to healthcare across regions. Although the law was later amended and some regions introduced alternative programs to restore access, disparities in healthcare access remain. This study aims to analyse the contribution of Community-based Health Insurance (CBHI), developed by migrant organisations, to improving healthcare access for Senegalese migrants in Spain.</p><p><strong>Methods: </strong>We conducted 28 in-depth interviews and one discussion group across various Spanish localities between 2019 and 2022 to examine how CBHI influences healthcare access among Senegalese migrants. Using purposive sampling, we ensured diversity in participants' administrative status, sociodemographic profiles, and employment situations. Grounded theory was employed to analyse the data, focusing on the social innovation and organizational dynamics of the tontines, as well as the role migrant organizations play in facilitating healthcare access through these solidarity-based financial mechanisms.</p><p><strong>Results: </strong>The findings show that CBHI has emerged as a socially innovative, collective response to unmet medical needs. Through the mobilization of community funds, Senegalese migrant organizations have filled gaps left by the public and private healthcare systems, offering a crucial alternative for those excluded from formal services. Our findings also highlight the rise of transnational healthcare trends, as community insurance funds are allocated not only for healthcare in Spain but also for return and care in Senegal. This dual focus demonstrates the importance of these grassroots microfinance initiatives in enhancing healthcare access for migrants.</p><p><strong>Conclusions: </strong>CBHI through tontines represents an essential community-led solution that enhances healthcare access for undocumented Senegalese migrants in Spain. Migrant organizations serve as key intermediaries, using solidarity-based microfinance models to bridge healthcare gaps left by restrictive policies. These initiatives demonstrate the capacity for grassroots innovation to address structural barriers to healthcare access in both destination and origin countries, providing a model for other migrant communities facing similar challenges.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1430"},"PeriodicalIF":2.7,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Amplifying youth voices: young people's recommendations for policy and practice to enhance vaccine acceptability.","authors":"Oluwaseyi Dolapo Somefun, Marisa Casale, Genevieve Haupt Ronnie, Joshua Sumankuuro, Olagoke Akintola, Chris Desmond, Lucie Cluver","doi":"10.1186/s12913-024-11630-8","DOIUrl":"10.1186/s12913-024-11630-8","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic has underscored the need for increased vaccine availability and uptake, with vaccine hesitancy posing a significant barrier, particularly among young adults. Evidence from various countries highlight high levels of hesitancy among young people, necessitating targeted interventions. Engaging young adults as key stakeholders in shaping public health strategies is crucial, as their perspectives can enhance vaccine acceptance. This study aimed to assess the overall acceptability of the COVID-19 vaccine among young people and to explore the factors influencing their willingness or reluctance to be vaccinated now and in the future.</p><p><strong>Methods: </strong>This study used qualitative data from 165 young adults in Nigeria, South Africa, and Zambia, to explore their suggestions for policies and strategies aimed at enhancing the acceptance of the Covid-19 vaccination among their age group. Data collection involved focus groups and interviews that explored participants' perceptions and recommendations regarding COVID-19 vaccination acceptability. Thematic analysis was used to analyse the data.</p><p><strong>Results: </strong>Thematic analysis identified several factors influencing vaccine acceptability among young people and suggested recommendations to improve it. The themes included developing targeted communication strategies for accurate vaccine information, offering alternative vaccination methods, promoting vaccine education in schools, and using trusted public figures to share accurate information.</p><p><strong>Conclusions: </strong>Persistent dissatisfaction with vaccine information dissemination underscores the need for more targeted communication strategies among young adults. Recommendations include developing non-injection vaccine options, incorporating vaccine education into school curricula and community programs, and leveraging influential public figures to build credibility. These insights are valuable for designing future programs to enhance vaccine acceptance among adolescents.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1425"},"PeriodicalIF":2.7,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health technology assessment to support health benefits package design: a systematic review of economic evaluation evidence in Zambia.","authors":"Warren Mukelabai Simangolwa, Kaymarlin Govender, Josue Mbonigaba","doi":"10.1186/s12913-024-11914-z","DOIUrl":"10.1186/s12913-024-11914-z","url":null,"abstract":"<p><strong>Background: </strong>Health technology assessment uses explicit economic evaluation evidence to support health benefits package design. However, the limited availability of technical expertise, data, and methods has restricted the production of economic evaluation evidence in low- and middle-income countries. Zambia has initiated a roadmap to support its policy of reviewing and implementing its national benefits package. This study characterises economic evaluation evidence to support this process's evidence mapping, synthesis, and appraisal stages.</p><p><strong>Methods: </strong>This systematic review applies deductive analysis and the preferred reporting items for systematic review and meta-analyses. Four databases were searched to identify studies from 1993 that coincided with Zambia's health benefits package reform.</p><p><strong>Results: </strong>A total of 61 studies met the inclusion criteria. Most of the studies were first authored by nonlocal authors, and the number of local-based authors in each study was low. Almost all funding for economic evaluation research was not local, and only a few studies sought local ethical clearance to conduct research. Infectious diseases were the highest disease control priority for the studies, with HIV research having the highest output. Most of the studies were cost-effectiveness studies that utilised trial-based data and a combination of program, published, and unpublished data for analysis. The studies generally utilised direct cost and applied the ingredient-based costing approach. Natural units were predominantly used for outcomes alongside DALYs. Most studies reported using a 3% discount rate for both costs and outcomes, with only a few reporting methods for sensitivity analysis.</p><p><strong>Conclusion: </strong>Economic evaluation evidence in Zambia has increased, revealing limited local research leadership, methodological inconsistencies, and a focus on infectious diseases. These findings are crucial for revising Zambia's benefits package and may guide researchers and decision-makers in improving the transparency and quality of future research.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1426"},"PeriodicalIF":2.7,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11572362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital nurses and physicians' experiences practicing patient safety work to recognize deteriorating patients: a qualitative study.","authors":"Astrid Marie Nysted Berg, Anne Werner, Ingrid Ruud Knutsen, Anne-Kari Johannessen","doi":"10.1186/s12913-024-11908-x","DOIUrl":"10.1186/s12913-024-11908-x","url":null,"abstract":"<p><strong>Background: </strong>Measures to increase patient safety work aim to prevent patient harm and injuries in hospitals and are a priority worldwide. Several hospitals have implemented various rapid response systems to strengthen patient safety. Knowledge is limited concerning how health professionals interact and how they experience competence development and master emergency situations. The aim of the study was to explore and describe hospital nurses' and physicians' experiences with patient safety work, and the implications of this work for collaboration and competence in a hospital.</p><p><strong>Methods: </strong>We used a qualitative descriptive design and interviewed 21 nurses and physicians from a hospital in Norway. Data were analysed with systematic text condensation, a four-step thematic cross-case analysis. The study adheres to the COREQ guidelines for conducting qualitative research.</p><p><strong>Results: </strong>Through analysis, three categories were identified: strengthening a common clinical language for patient deterioration; sharing and transferring competencies across hospital wards and amongst professionals; and balancing time pressure and limited resources. The results showed that the patient safety work contributed to building bridges between health professionals and across hospital levels regarding deteriorating patients. It also provided structure and systematization to the hospital professionals' work with deteriorating patients. However, the results also demonstrated the complexity of maintaining patient safety, pointing to the need to balance limited time and resources in hospital.</p><p><strong>Conclusions: </strong>The patient safety work presumably provides better emergency care, which may enhance patient safety in hospital. The complexity of hospital work, however, can influence the patient safety performance negatively, requiring health professionals to adopt robust, up-to-date skills and competencies in observing and assessing patient deterioration. In a busy hospital setting, the ability of health professionals to collaborate and communicate is important as they are faced with the challenges of balancing time-pressure and limited resources, which can potentially compromise patient safety work.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1429"},"PeriodicalIF":2.7,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physiotherapists as first-contact practitioners for patients with low back pain in French primary care: a pragmatic cluster randomised controlled trial.","authors":"Amélie Kechichian, François Desmeules, Pauline Girard, Hugo Terrisse, Céline Vermorel, Nicolas Pinsault","doi":"10.1186/s12913-024-11814-2","DOIUrl":"10.1186/s12913-024-11814-2","url":null,"abstract":"<p><strong>Background: </strong>A new model of care enables French physiotherapists (PT) working in collaboration with family physicians (FP) to expand their usual scope of practice for patients with acute low back pain (LBP). The aim of our study is to evaluate the impact of this new first-contact physiotherapy (FCP) advanced practice model compared to usual FP care.</p><p><strong>Methods: </strong>A multicentre pragmatic non-inferiority cluster randomised controlled trial (RCT) has been conducted in six multidisciplinary primary healthcare centres in France. Patients from 20 to 55 years old with acute LBP consulted either the PT or the FP. PT independently assessed and managed patients including medication prescription. The primary outcome measure was disability at six weeks (Roland Morris Disability Questionnaire, range 0-24). Secondary outcomes include pain, risk disability prognosis, satisfaction with care, healthcare resources use and wait times. Data were collected at baseline, six and twelve weeks. Outcomes across arms were compared using mixed models regression analysis. Except for non-inferiority analysis of the primary outcome measure, other analyses were performed with a two-sided significance level of 0.05.</p><p><strong>Results: </strong>Sixty patients were recruited (PT: 32, FP: 28). The adjusted mean difference between groups for disability at 6 weeks was 0.39 in favour of the FP group (95%CI: -2.03; 2.81, p = 0.753). Considering a 5 points minimal clinically important difference, the FCP-led model of care was not inferior to usual FP care for the primary outcome. There was no statistically significant difference between groups in disability at 3 months and pain at 6 weeks and 3 months. PTs prescribed significantly less medications than FPs (p < 0.001). No statistically significant difference was found for other healthcare resource use outcomes, patients' satisfaction and wait times.</p><p><strong>Conclusion: </strong>This is the first RCT to evaluate the impact of a FCP advanced practice model of care including medical delegated acts in a primary care setting. Our results suggest that the FCP-led model of care is not inferior to usual FP care regarding disability at 6 weeks. The FCP model could result in possible benefits in terms of healthcare resources use. Further adequate powered studies with larger sample size are needed to draw stronger conclusions.</p><p><strong>Trial registration: </strong>The study has been registered in ClinicalTrials.gov (NCT05200533) on the 20th of January 2022.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1427"},"PeriodicalIF":2.7,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11572111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of direct health facility financing on MNCH service provision: results from a comparative, before-after study in Pwani Region, Tanzania.","authors":"Kyoung Kyun Oh, Joy G Ferdinand, Ntuli A Kapologwe, Benedicto M Ngaiza, Joyce M Gordon, Doowon Lim, Alfred E Ngowi, Swabaha A Yusuph, Hayoung Kim, Hansol Park, Sooyoung Ahn, Bok Hyun Nam, Chang-Yup Kim","doi":"10.1186/s12913-024-11917-w","DOIUrl":"10.1186/s12913-024-11917-w","url":null,"abstract":"<p><strong>Background: </strong>Pwani Regional Secretariat in Tanzania implemented the Maternal, Neonatal, and Child Health Project (2016-2022) through Direct Health Facility Financing (DHFF), which allocates funds directly to health facilities. This study assessed the impact of the six-year DHFF project in Pwani region.</p><p><strong>Methods: </strong>The study utilised District Health Information Software 2 data from 18 intervention health facilities in Pwani region. Control groups comprised an equal number of facilities from Pwani and Dodoma regions where the project was not implemented. Key indicators assessed included 'ANC 4 + Rate (%)', 'Percentage of Mothers tested for Anaemia during ANC', 'Caesarean Section Delivery Rate (%)', 'Percentage of Mothers and Newborns receiving PNC services within 48 hours', 'Delivery Complication Rate (%)', and 'SBA Delivery Rate (%)' which are associated with the project interventions. The impact of the project was analysed using a paired sample t-test comparing baseline and endline data. We evaluated the significance of the dependent variables using one-way ANOVA with control groups, with the Tukey-Kramer test for post hoc analysis. Chi-square test assessed the significance of Caesarean Section Delivery Rate and the relationship between variables and health facility conditions. Pearson correlation test was used for significance between funding size and the change of MNCH variables. Statistical significance at 0.05 was calculated.</p><p><strong>Results: </strong>The project showed limited positive impacts, only in the 'Percentage of Mothers tested for Anaemia during ANC' (****p < 0.0001), 'Percentage of Newborns receiving PNC within 48 hours' (**p = 0.0095), and 'SBA Delivery Rate' (***p = 0.0043). The health facility assessment identified positively influencing factors on service delivery, such as facility type (*p = 0.0347), distance to the facility (****p < 0.0001), and internet connectivity (*p = 0.0186). We found that the project did not improve most MNCH indicators, including the CEmONC coverage (χ2 = 2.82, p = 0.2448, df = 2), which was known to be the leading outcome.</p><p><strong>Conclusion: </strong>The project had limited impacts on MNCH outcomes due to various factors. While the health facility assessment highlighted positive influences on service delivery, significant areas for improvement remain, including referral systems and infrastructure. Operational research findings indicate that the effectiveness of the DHFF could be enhanced by refining its management and governance structures.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1424"},"PeriodicalIF":2.7,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}