Uncovering the determinants of health in deprived urban neighborhoods in Accra, Ghana: a qualitative and participatory reconnaissance study.

Background: Delivering primary care services within the context of rapid urbanization and a changing disease burden is a major challenge in sub-Saharan Africa. Rural models of primary care, including the "Community-based Health Planning and Services" (CHPS) programme in Ghana, have shown improved health outcomes. However, adapting these to the urban context has proved problematic. Differences in the determinants of health found in these settings may help to explain the challenges of delivering CHPS in poor urban neighborhoods in Accra. To inform the redesign of CHPS for the urban context, we aimed to understand the determinants driving health and engagement with health services in three informal settlements in Accra. Methods: This study formed a reconnaissance phase for a subsequent participatory action research study. We used qualitative and participatory methods to explore the influence of wider and proximal determinants on health and the use and perceptions of CHPS. Three transect walks with community leaders across the study settings informed interview guides and the recruitment of suitable participants for key informant and focus group interviews. Using a Framework Approach, we analysed transcripts and reports from these activities and developed themes and sub-themes in participants' experiences accessing healthcare. Results: Our findings highlight the importance of wider and proximal determinants of health including physical environment, gender and other social stratifiers including age, ethnicity, religion and disability, on health, health seeking behavior and personal behaviors such as substance misuse, tobacco use and alcohol. Utilization of CHPS was low and seen primarily as a service for maternal and child health. Private providers, ranging from informal drug stores to private clinics, were used most commonly. Community leaders and groups were active, but engagement was limited by opportunity costs for members. Conclusion: Traditional service delivery packages need to be adapted to include non-communicable diseases driven by risk behaviors such as tobacco, unhealthy diet, alcohol and substance abuse. Assets such as volunteerism and nurses embedded within communities are challenging to attain in complex urban settings, yet other assets exist including occupational associations and a range of informal and private providers that could support delivery of preventive and promotive health care with equitable reach.

Assessing the nonlinear impact of green space exposure on psychological stress perception using machine learning and street view images.

Introduction: Urban green space (GS) exposure is recognized as a nature-based strategy for addressing urban challenges. However, the stress relieving effects and mechanisms of GS exposure are yet to be fully explored. The development of machine learning and street view images offers a method for large-scale measurement and precise empirical analysis. Methods: This study focuses on the central area of Shanghai, examining the complex effects of GS exposure on psychological stress perception. By constructing a multidimensional psychological stress perception scale and integrating machine learning algorithms with extensive street view images data, we successfully developed a framework for measuring urban stress perception. Using the scores from the psychological stress perception scale provided by volunteers as labeled data, we predicted the psychological stress perception in Shanghai's central urban area through the Support Vector Machine (SVM) algorithm. Additionally, this study employed the interpretable machine learning model eXtreme Gradient Boosting (XGBoost) algorithm to reveal the nonlinear relationship between GS exposure and residents' psychological stress. Results: Results indicate that the GS exposure in central Shanghai is generally low, with significant spatial heterogeneity. GS exposure has a positive impact on reducing residents' psychological stress. However, this effect has a threshold; when GS exposure exceeds 0.35, its impact on stress perception gradually diminishes. Discussion: We recommend combining the threshold of stress perception with GS exposure to identify urban spaces, thereby guiding precise strategies for enhancing GS. This research not only demonstrates the complex mitigating effect of GS exposure on psychological stress perception but also emphasizes the importance of considering the "dose-effect" of it in urban planning and construction. Based on open-source data, the framework and methods developed in this study have the potential to be applied in different urban environments, thus providing more comprehensive support for future urban planning.

A Digital Sexual Health Intervention for Urban Adolescent and Young Adult Male Emergency Department Patients: User-Centered Design Approach.

BACKGROUND: Adolescents and young adults frequently present to the emergency department (ED) for medical care and continue to have many unmet sexual health needs. Digital interventions show promise to improve adolescent and young adult sexual health; yet, few interventions focus on male ED patients, despite their infrequent use of contraceptives and rising rates of sexually transmitted infections. OBJECTIVE: This paper describes the design and development of Dr. Eric (Emergency Room Interventions to Improve Care), a digital app focused on promoting condom use among sexually active adolescent and young adult male ED patients. METHODS: This study followed 4 phases of app development, which were based on user-centered design and the software development lifecycle. In phase 1, define, we explored our target population and target health problem (infrequent condom use among male ED patients) by collecting key stakeholder input and conducting in-depth interviews with male patients and urban ED medical providers. In phase 2, discover, we partnered with a digital product agency to explore user experience and digital strategy. In phase 3, design, we refined Dr. Eric's content, a 5-part sexual health educational module and a 10-week SMS text messaging program that focuses on condom use and partner communication about effective contraceptives. We conducted semistructured interviews with male adolescent and young adults to gather feedback on the app and perform usability testing, editing the app after each interview. We also interviewed informatics experts to assess the usability of a high-fidelity prototype. Interviews were recorded and analyzed via descriptive thematic analysis; informatic expert feedback was categorized by Nielsen's heuristic principles. In phase 4, develop, we created the technical architecture and built a responsive web app. These findings were gathered leading to the final version of the digital Dr. Eric program. RESULTS: Using data and key stakeholder input from phases 1 and 2, we iteratively created the Dr. Eric prototype for implementation in the ED setting. Interviews with 8 adolescent and young adult male ED patients suggested that users preferred (1) straightforward information, (2) a clear vision of the purpose of Dr. Eric, (3) open-ended opportunities to explore family planning goals, (4) detailed birth control method information, and (5) games presenting novel information with rewards. Five usability experts provided heuristic feedback aiming to improve the ease of use of the app. These findings led to the final version of Dr. Eric. CONCLUSIONS: Following these mobile health development phases, we created a digital sexual health mobile health intervention incorporating the principles of user experience and interface design. Dr. Eric needs further evaluation to assess its efficacy in increasing condom use among adolescent and young adult male ED patients. Researchers can use this framework to form future digital health ED-based digital interventions.

Development of a stakeholder-engaged tool to evaluate community convening and promote community health.

BACKGROUND: Health systems support community health and well-being, and while many commit resources to convening in support of community-engaged communication interventions, they currently lack tools to evaluate this effort. This report describes one health system's mixed-methods stakeholder-engaged development of robust yet pragmatic convening assessment tools. METHODS: Semi-structured interviews and web surveys with key stakeholders informed a taxonomy of quality convening and accompanying survey tool. Initial evidence of validity and item variability were assessed descriptively. RESULTS: A 3-item survey aligned with high-priority convening constructs was developed with adequate variability in initial item responses. A companion 21-construct taxonomy organized by domain and stakeholder also resulted. CONCLUSION: This project resulted in a taxonomy detailing the constructs of quality convening and an accompanying brief survey tool to meets the needs of groups convened by one health system. These tools provide a unique opportunity to measure the quality of community convening within the context of healthcare.

A Randomized Controlled Trial of a Digital Intervention to Improve the Sexual Health of Adolescent and Young Adult Male Emergency Department Patients.

PURPOSE: To assess implementation outcomes and potential efficacy of a user-informed, theory-based digital health intervention developed to improve adolescent and young adult (AYA) male sexual health. METHODS: We conducted a pilot randomized controlled trial of sexually active male emergency department (ED) patients aged 14-21 years. Participants were randomized to the intervention (Dr. Eric, Emergency Room Interventions to improve Care) or usual care. Dr. Eric consists of an ED-based sexual health app followed by 3 months of interactive text messages. We assessed the feasibility, adoption, and fidelity among users. Condom use, defined as the number of sexual encounters with condoms divided by the total number of sexual encounters over the past 4 weeks, was the primary efficacy outcome. RESULTS: We enrolled 119 patients; mean age was 17.9 years, 87% were Hispanic, and half used condoms at last intercourse. Dr. Eric demonstrated feasibility, with high rates of consent (86.2%) and follow-up (81.5%). Intervention participants found Dr. Eric acceptable, liking (86.2%) and recommending (87.9%) the program. 98% of intervention participants interacted with all five app modules; one-quarter opted out of text messaging. At 6-week follow-up, the intervention group more often used a condom compared to the control group [OR 3.57, 95% confidence interval (1.93, 6.60)], p < .001]; however, this significant difference did not sustain at 13 weeks. DISCUSSION: Dr. Eric was feasible to deliver and acceptable to male AYA patients. To our knowledge, Dr. Eric is the first intervention to demonstrate evidence of short-term efficacy for improving condom use among male AYA in the ED.

Financing immunisation in Kenya: examining bottlenecks in health sector planning and budgeting at the decentralised level.

BACKGROUND: Decentralisation has increasingly been adopted by countries as an important health sector reform aimed at increasing community participation in decision making while enhancing swift response at decentralised levels, to accelerate the attainment of health system goals. Kenya adopted a devolved system of government where health services delivery became a function of the 47 semi-autonomous county governments with planning and budgeting functions practised at both levels of government. This study sought to explore challenges facing health sector planning and budgeting and how they affect immunisation service delivery at the county level. METHODS: Data were collected through 77 in-depth interviews of senior county department of health officials across 15 counties in Kenya. We applied an inductive thematic approach in analysing the qualitative data using NVIVO software. FINDINGS: The study found a lack of alignment between planning and budgeting processes, with planning being more inclusive compared to budgeting. Inadequate capacity in conducting planning and budgeting and political interference were reported to hinder the processes. Limited budget allocations and delayed and untimely disbursement of funds were reported to affect execution of health and immunisation budgets. Low prioritisation of preventive health interventions like immunisation due to their perceived intangibility influenced resource allocation to the programs. CONCLUSION: The findings highlight the need for effective strategies to align planning and budgeting processes, increased technical support to counties to enhance the requisite capacity, and efforts to improve budget execution to improve budget credibility. Counties should plan to increase their funding commitment toward immunisation to ensure sustainability of the program as Kenya transitions from GAVI support.

Illicit drug use in Limerick City: A stakeholder and policy analysis using multiple streams model.

BACKGROUND: The changing drug situation in Ireland has led to the development of various drug policies. This paper aims to use Limerick City as a case study to examine approaches to policy development. METHODOLOGY: The study is qualitative and uses a hybrid technique that combines document, content, and stakeholder analysis. Kingdon's multiple streams model underpins this study. In addition, guidelines for the systematic search for grey literature were adopted as the search strategy. RESULTS: Problem Stream: Illicit drug use and its related problems have changed. The increasing availability of drugs, increasing usage and changes in the types of drugs being used have led to increased drug-related crimes, adverse health outcomes and elevated demand for treatment services. Local drug policies and initiatives emerge by recognising drug-related problems in the region. Policy Stream: The current national drug strategy 2017-2025 which informs action plans in Limerick is the first to focus on a unified health approach. Some national policies have evolved to ensure that guidelines meet current service needs. However, these changes have occurred in some cases with no clear actions. Political Stream: Statutory, voluntary and community stakeholders provide drug addiction and drug addiction-related services, which have evolved rapidly since their first introduction. The Mid-West Regional Drug Task Force was identified as essential in coordinating stakeholders locally. One area for improvement is limited evidence of the voices of persons who take drugs included in service/policy development. This regional analysis also suggests that local implementation of policies concerning dual diagnosis and supervised injection facilities can be further expanded. Despite the challenges experienced by stakeholders in Limerick, a hands-on approach has been adopted in the creation of strategies to tackle the drug problem. CONCLUSION: The approaches to drug policy development have delivered continuous development of services. However, services remain underdeveloped in areas removed from the capital city of Dublin. Navigating the complex drug landscape reveals that inclusivity, adaptation, and ongoing research are critical components of successful and long-lasting drug policies.

Decisional needs for older adults, home health care nurses and dental hygienists during team-based oral health assessments in ordinary home settings - a qualitative study.

BACKGROUND: Participation by all actors involved in health planning is a prerequisite for person-centred care and healthy ageing. Understanding the multiple knowledge needs and the values that shape oral health assessments in home settings is important both to enable participation in oral health planning and to contribute to healthy ageing. OBJECTIVE: The aim of this study was to investigate decisional needs during oral health assessments in ordinary home settings from the perspectives of older adults, home health care nurses and dental hygienists. METHODS: Data was collected in ordinary home settings through 24 team-based oral assessments and 39 brief, semi-structured interviews including older adults (n = 24), home health care nurses (n = 8) and dental hygienists (n = 7). Data was analysed using content analysis with a deductive approach. The analysis was guided by the Ottawa Decision Support Guide. RESULTS: The analysis revealed that all participants considered participation in decision-making important but until now, older adults might not have participated in making decisions regarding oral health issues. The older adults considered participation important because the decisions had a strong impact on their lives, affecting their health. The professionals considered decision-making important for knowing what step to take next and to be able to follow up and evaluate previous goals and treatments. Organizational and personal barriers for shared decision-making among home health care nurses and dental hygienists were identified. Of the 24 older adults, 20 had different oral health conditions that objectively indicated the need for treatment. An initial important decision concerned whether the older adult wanted to make an appointment for dental care, and if so, how. Another decisional conflict concerned whether and how assisted oral care should be carried out. CONCLUSION: It is important for key participants in ordinary home settings to participate in interprofessional teams in home health care. To further anchor this in theory, conceptual models for professionals from different care organizations (municipal care, dental care) need to be developed that also involve older adults as participants. Future research could bridge theory and practice by including theories of learning while exploring interorganizational oral health planning in home settings.

Utilization of health-related data in the regional context for health service planning in the Federal State of Brandenburg, Germany-a qualitative study.

BACKGROUND: Utilizing regional health data goes hand in hand with challenges: can they be used for health planning, are they applicable to the relevant topics? The study explores current data utilization and needs of stakeholders working in regional health services planning. METHODS: We conducted 16 semi-structured expert-interviews with stakeholders of regional health planning in Brandenburg, a federal state in the north-east of Germany, by telephone or online-meeting tools between 05/2022 and 03/2023. The data were analysed according to qualitative content analysis. RESULTS: Utilization of data sources depends on individual knowledge and personnel resources instead of being guided by standardized procedures. Interviewees primarily use internal data; some use many different platforms, studies and reports. Regional health-related data are used for reliable health planning, to prepare resolutions, draft contracts, but also for events and requests from policy makers or the press. Challenges exist in terms of availability, awareness, and acceptance of the data, perceived applicability, the ability to use it and the utilization itself. Many regional health planners indicated they would appreciate a regional integrated cross-organizational data source if the benefits for health planning outweighed the efforts. DISCUSSION: Actors in health planning primarily utilized their own data for planning; additional data sources are not available or the level of aggregation is too high, not known by them or are often not used due to a lack of time. A standardized regional monitoring would require the definition of indicators as well as the strengthening of cross-sectoral planning.

Components and entities of post-disaster damage and loss assessment program in healthcare sector: a scoping review.

BACKGROUND: Disasters can cause casualties and significant financial loss. In accordance with the Sendai Framework for Disaster Risk Reduction, areas affected by disasters must be built back better. Accurate post-disaster damage and loss assessments are critical for the success of recovery programs. This scoping review aimed to identify the components and entities of the healthcare sector's post-disaster damage and loss assessment program. METHODS: An comprehensive search for relevant literature was performed using several databases, including the Web of Science, PubMed, Scopus, ProQuest, and Magiran. The search was limited to papers published between 2010 and 2022. In addition, we searched the grey literature for resources related to post-disaster damage and loss assessments. Study selection and data extraction were evaluated by a third reviewer. The main themes were determined through a consensus process and agreement among team members. RESULTS: A total of 845 papers were identified, 41 of which were included in the review. The grey literature search yielded 1015 documents, 23 of which were associated with the study's purpose. The findings were classified into five main themes, 20 subthemes, and 876 codes. The main-themes include the following: Concepts and Definitions; Post-Disaster Damage and Loss Assessment Procedures; Healthcare sector procedures; Assessments Tools, and Methods; Intra-sectoral, Inter-sectoral, and cross-cutting issues. CONCLUSIONS: The existing corpus of literature on post-disaster damage and loss assessment programs within the healthcare sector offers only limited insights into the entities and components involved. It is of great importance that stakeholders have an extensive grasp of these pivotal concepts and principles, as they are fundamental in enabling effective responses to disasters, informed decision-making, and facilitating rehabilitation and reconstruction efforts. Consequently, there is a considerable scope for further investigation in this area. SCOPING REVIEW REGISTRATION NUMBER: https://osf.io/nj3fk .

Comparative efficacy of various exercise types and doses for depression in older adults: a systematic review of paired, network and dose-response meta-analyses.

OBJECTIVES: We assessed the effects of different exercise modalities and doses on depression levels in older adults. METHODS: Systematic searches of the PubMed, Web of Science, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus databases were conducted from the start of database construction until December 2023. Studies were included if they were randomised controlled trials (RCTs) of exercise interventions in older adults. Pairwise, network and dose-network meta-analyses were conducted using random-effects models for the outcome of depression in older adults. RESULTS: A total of 80 RCTs with 5536 participants were included in this study. Network meta-analyses showed that resistance exercise [standardized mean difference (SMD) = - 0.68, 95% confidence interval (CI): - 0.90, - 0.46] and mind-body exercise (MBE; SMD = - 0.54, 95% CI: - 0.72, - 0.37) were the most effective forms of exercise for improving depression in older adults, followed by aerobic exercise (SMD = - 0.31, 95% CI: - 0.50, - 0.13) and mixed exercise (SMD = - 0.23, 95% CI: - 44, - 0.01). In addition, a U-shaped dose-response relationship was found between overall exercise dose and depression levels in older adults, and a significant response was seen after 390 metabolic equivalent (MET)-min/week. CONCLUSIONS: Our study determined the effectiveness of different exercises in improving levels of older adults and found that resistance exercise and MBE were more effective adjunctive treatments. By providing the most effective treatments, older adults can reap the benefits of improving depression in older adults at doses lower than the World Health Organization guidelines.

The Self-Care of Older Australians During Bushfires and COVID-19: A Qualitative Study.

OBJECTIVE: This article sought to explore how older people maintained their health and managed chronic conditions during the 2019-2020 Black Summer bushfires, floods, and COVID-19 pandemic in Australia. This knowledge is important in the context of intersecting public health and environmental hazards. METHODS: Qualitative, semi-structured interviews were undertaken with 19 community-dwelling older people living in South Eastern New South Wales, a region significantly impacted by the successive disasters. RESULTS: Three themes summarized participants' experiences. Participants described disruption to daily activities and social networks, delayed treatment and disruption to health services, and the exacerbation of health issues and emergence of new health challenges as challenges to managing health and self-care . Strategies for staying healthy were described as drawing on connections and relationships and maintaining a sense of normalcy. Finally, the compounding nature of disasters highlighted the impact of successive events. CONCLUSIONS: Understanding older people's experiences of self-care during disasters is critical for developing interventions that are better targeted to their needs. This study highlights the importance of social connectedness, habit, and routine in health and well-being. Results should inform policymaking and guide interventions in health care for older people.

[Specific proposals for organising an agency for evaluating the efficiency of health technologies and policies]. / Propuestas concretas para organizar una agencia de evaluación de la eficiencia de tecnologías y políticas sanitarias.

We describe in detail a twofold proposal for the creation, organization and sequential development of two bodies responsible for evaluating the efficiency of health technologies and policies in Spain and its possible design. It would constitute a key element in the process of re-organising the National Health System. The first, which could be adopted immediately, would be called the Office for the Evaluation of the Efficiency of Medicines, would be attached to the Spanish Agency for Medicines and Medical Devices as a functionally independent body and limited to evaluating the efficiency of medicines. The second, the National Health Evaluation Commission, in the form of an independent administrative body, would evaluate health technologies and possibly public health policies. Functional independence, adequate resources and anchoring in the values of good governance are the defining characteristics of this dual proposal.

[When should a liver disease patient be admitted to the intensive care unit?] / Wann soll ein Leberkranker auf die Intensivstation?

Liver diseases are a significant global cause of morbidity and mortality. Liver cirrhosis can result in severe complications such as bleeding, hepatic encephalopathy (HE), and infections. Implementing a clear strategy for intensive care unit (ICU) admission management improves patient outcomes. Hemodynamically significant esophageal/gastric variceal bleeding (E/GVB) and grade 4 HE, when accompanied by the need for renal replacement therapy (RRT), are definitive indications for ICU admission. E/GVB, spontaneous bacterial peritonitis (SBP), and infections with multidrug-resistant organisms (MDRO) require close and stringent critical assessment. Patients with severe hepatorenal syndrome (HRS) or respiratory failure have increased baseline mortality and most likely benefit from early ICU treatment. Rapid identification of sepsis in patients with liver cirrhosis is a crucial criterion for ICU admission. Prioritizing cases based on mortality risk and clinical urgency enables efficient resource utilization and optimizes patient management. In addition, "Liver Units" provide an intermediate care (IMC) level for patients with liver diseases who require close monitoring but do not need immediate intensive care.

Effectiveness, acceptability, and potential of lay student vaccinators to improve vaccine delivery.

SETTING: Task sharing can fill health workforce gaps, improve access to care, and enhance health equity by redistributing health services to providers with less training. We report learnings from a demonstration project designed to assess whether lay student vaccinators can support community immunizations. INTERVENTION: Between July 2022 and February 2023, 27 undergraduate and graduate students were recruited from the University of Toronto Emergency First Responders organization and operated 11 immunization clinics under professional supervision. Medical directives, supported with online and in-person training, enabled lay providers to administer and document vaccinations when supervised by nurses, physicians, or pharmacists. Participants were invited to complete a voluntary online survey to comment on their experience. OUTCOMES: Lay providers administered 293 influenza and COVID-19 vaccines without adverse events. A total of 141 participants (122 patients, 17 lay vaccinators, 1 nurse, and 1 physician) responded to our survey. More than 80% of patients strongly agreed to feeling safe and comfortable with lay providers administering vaccines under supervision, had no concerns with lay vaccinators, and would attend another lay vaccinator clinic. Content and thematic analysis of open-text responses revealed predominantly positive experiences, with themes about excellent vaccinators, organized and efficient clinics, and the importance of training, communication, and access to regulated professionals. The responding providers expressed comfort working in collaborative immunization teams. IMPLICATIONS: Lay student providers can deliver vaccines safely under a medical directive while potentially improving patient experiences. Rather than redeploying scarce professionals, task sharing strategies could position trained lay vaccinators to support immunizations, improve access, and foster community engagement.

RéSUMé: LIEU: Le partage de tâches peut combler les pénuries de personnels de santé et améliorer l'accès aux soins et l'équité en santé en redistribuant les services de santé vers des prestataires ayant moins de formation. Nous rendons compte des enseignements d'un projet de démonstration visant à déterminer si des vaccinateurs étudiants profanes pourraient appuyer l'immunisation communautaire. INTERVENTION: Entre juillet 2022 et février 2023, 27 étudiantes et étudiants de premier cycle et de cycles supérieurs ont été recrutés auprès de l'organisation des secouristes opérationnels de l'Université de Toronto pour gérer 11 cliniques de vaccination sous la supervision de personnel spécialisé. Des directives médicales, appuyées par une formation en ligne et en présentiel, ont permis à ces prestataires profanes d'administrer des vaccins et de les consigner en dossier sous la supervision d'infirmières, de médecins ou de pharmaciens. Les personnes participantes ont été invitées à répondre à un sondage en ligne sur leur expérience. RéSULTATS: Les prestataires profanes ont administré 293 vaccins contre la grippe et la COVID-19 sans manifestations postvaccinales indésirables. En tout, 141 personnes (122 patients, 17 vaccinateurs profanes, 1 infirmière et 1 médecin) ont répondu au sondage. Plus de 80 % des patients ont dit se sentir tout à fait en sécurité et à l'aise de recevoir des vaccins administrés par des prestataires profanes sous supervision, n'avoir aucune inquiétude vis-à-vis des vaccinateurs profanes et être disposés à se présenter à une autre clinique gérée par des vaccinateurs profanes. L'analyse du contenu et des thèmes des réponses aux questions ouvertes a révélé des expériences majoritairement positives, et des thèmes axés sur l'excellence des vaccinateurs, l'organisation et l'efficacité des cliniques, ainsi que l'importance de la formation, des communications et de l'accès à des professionnels réglementés. Les prestataires ayant répondu au sondage se sont dit à l'aise de travailler au sein d'équipes de vaccination collaboratives. CONSéQUENCES: Des prestataires étudiants profanes peuvent administrer des vaccins en toute sécurité en suivant une directive médicale, et cela peut potentiellement améliorer l'expérience des patients. Plutôt que de redéployer des ressources professionnelles limitées, les stratégies de partage de tâches pourraient placer des vaccinateurs profanes formés pour appuyer l'immunisation, améliorer l'accès et favoriser l'engagement communautaire.

Improving maternal and child nutrition services in community based health planning and services zones in the jirapa municipality of northern ghana-challenges and strategies: the perspective of community health officers.

BACKGROUND: The Community-based Health Planning and Services (CHPS) initiative plays a key role in delivering maternal and child health nutrition services in Ghana. This study explored bottle necks hindering the delivery of maternal and child nutrition services at CHPS zones and searched for strategies to address them from the perspective of community health officers in rural Northern Ghana. METHODS: An exploratory qualitative cross-sectional study design using key informant interviews involving the municipal nutrition officer and Community Health Officers (CHOs) from eleven CHPS zones was carried out in April 2019. Manual data analysis was done using the framework analysis approach in qualitative data analysis for applied policy research. RESULTS: This study identified challenges of maternal and child nutrition services in the Jirapa municipality to be municipal health directorate and CHPS zone based in nature. Municipal health directorate based challenges were inadequate logistics/medicines; lack of staff training; lack of supervision/monitoring; and inadequate financial support/motivation/incentives. CHPS zone based challenges were lack of planning activities by staff; inadequate home visits; lack of commitment by staff; and lack of community meetings/engagements. Proposed strategies to address municipal health directorate based challenges included adequate provision of logistics/medicines; frequent training of staff in maternal and child nutrition related issues; frequent supervision/monitoring activities from the municipal health directorate; and providing financial support/motivation/incentives at the CHPS zones. Proposed strategies to address CHPS zone based challenges were planning of activities; improved home visits; increased commitment towards delivering maternal and child nutrition services; and frequent community meetings/engagements. CONCLUSION: In order to improve maternal and child nutrition services at CHPS zones, there is the need to address certain systemic challenges at both the municipal or district health directorate and CHPS zones levels of the primary health care system. It is recommended that, the Municipal Health Directorate; the Municipal Health Management Team; the Municipal Assembly and all relevant stakeholders involved in improving maternal and child nutrition services at the community level, actively engage CHOs to help address the systemic challenges.

Community-Based Health Planning and Services (CHPS) concept and access to healthcare delivery in Sefwi Wiawso Municipal, Ghana.

BACKGROUND: In spite of the successes of the community-based health planning and services (CHPS) policy since its inception in the mid-1990s in Ghana, data pertaining to the implementation and use of CHPS facilities in Sefwi Wiawso Municipal is scant. We assessed access to healthcare delivery and factors influencing the use of CHPS in Sefwi Wiawso Municipal. METHODS: An analytical community-based cross-sectional study was conducted in the Sefwi Wiawo Municipal from September to October 2020. Respondents for the study were recruited through multi-stage sampling. Information was collected on their socio-demographic characteristics, knowledge and use of CHPS facilities through interviews using a structured pre-tested questionnaire. Factors influencing the use of CHPS facilities were assessed using univariable and multivariable logistic regression to generate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). P ≤ 0.05 was considered statistically significant. RESULTS: A total of 483 respondents were recruited for the study. The mean age of the respondents was 43.0 ± 16.3 years, and over 70% were females or married/cohabiting with their partners. Most respondents (88.2%) knew about the CHPS concept and more than half (53.4%) accessed healthcare in the CHPS facilities. Most respondents rated the quality of health services (> 65%) and staff attitude (77.2%) very positively. Significant factors influencing the use of the CHPS facilities were; knowledge of the CHPS concept (AOR 6.57, 95% CI 1.57-27.43; p = 0.01), longer waiting time for a vehicle to the facility, and shorter waiting time at the facility before being provided with care. People who waited for 30-60 min (AOR 2.76, 95% CI 1.08-7.07; p = 0.01) or over an hour (AOR 10.91, 95% CI 3.71-32.06; p = 0.01) before getting a vehicle to the facility, while patients who waited for less than 30 min (AOR 5.74, 95% CI 1.28-25.67; p = 0.03) or 30-60 min (AOR 2.60, 95% CI 0.57-11.78; p = 0.03) at the CHPS facility before receiving care were more likely to access care at the CHPS facilities. CONCLUSION: Knowledge, and use of healthcare services at the CHPS facilities were high in this population. Interventions aimed at reducing waiting time at the CHPS facilities could greatly increase use of healthcare services at these facilities.

Os Determinantes Sociais da Saúde no planejamento da testagem à covid-19 no Amazonas, Brasil / The Social Determinants of Health in the planning of COVID-19 testing in Amazonas, Brazil

RESUMO A sindemia da covid-19 afetou desproporcionalmente populações mais vulneráveis do ponto de vista social, como pessoas de baixa renda, populações indígenas e ribeirinhas. No estado do Amazonas, onde a geografia única e as disparidades sociais apresentam desafios significativos para o acesso e a equidade em saúde, os Determinantes Sociais da Saúde (DSS) desempenham um papel crucial. Este artigo analisa se e como os DSS foram considerados durante o planejamento de testes para a covid-19 no Amazonas. Para tal análise, realizou-se um estudo de caso qualitativo por meio de análise documental e entrevistas semiestruturadas com atores-chave envolvidos no planejamento e na implementação da testagem. Os documentos oficiais foram sistematizados usando TIDieR-PHP. Os dados foram analisados empregando a ferramenta REFLEX-ISS. Os DSS não foram considerados no planejamento de testes no Amazonas. Não houve consenso entre os entrevistados sobre a importância de considerar os DSS no planejamento da intervenção. Os testes foram restritos a pacientes com sintomas graves e a algumas categorias de trabalhadores em serviços considerados essenciais. Faz-se necessário, aos gestores de políticas de saúde, conhecimento sobre a importância de considerar os DSS no planejamento em intervenções populacionais para realizar uma política equânime.

ABSTRACT The COVID-19 syndemic has disproportionately affected socially vulnerable populations, such as low-income individuals, Indigenous peoples, and riverine communities. Social Determinants of Health (SDH) have played a crucial role in the state of Amazonas, where unique geography and social disparities pose significant challenges to health access and equity. This article examines whether and how SDH were considered during COVID-19 testing planning in Amazonas. For this analysis, we conducted a qualitative case study through document analysis and semi-structured interviews with key stakeholders involved in testing planning and implementation. Official documents were systematized using TIDieR-PHP, and data were analyzed using the REFLEX-ISS tool. SDH were not considered in testing planning in Amazonas. The respondents could not all agree on the importance of considering SDH in intervention planning. Testing was limited to patients with severe symptoms and specific categories of essential workers. Health policymakers need to understand the relevance of considering SDH in planning population interventions to ensure equitable policy implementation.