Perceived outcomes of medical teaching institute reforms: insights from management, faculty, and administration in Pakistani tertiary health care.

OBJECTIVE: The study aims to explore the perceived outcomes of Medical Teaching Institution (MTI) reforms on autonomy and overall performance within tertiary healthcare institutions in Khyber Pakhtunkhwa (KP) province, Pakistan. METHODOLOGY: A cross-sectional study was carried out from September 2023 to March 2024, involving interviews with frontline staff, administrative personnel, and senior management within MTI-affiliated institutions. The methodology employed, using both qualitative and quantitative data analysis techniques. RESULTS: The study showed that institutional staff members' knowledge and understanding of the MTI changes differed. Some observed very minor adjustments, while others saw advances in hospital operations and service delivery. Administrative complexity, political meddling, and resource allocation problems were noted as challenges. Positive results were also observed, though, and they included improved infrastructure, possibilities for staff training, and decision-making procedures. CONCLUSION: Despite significant improved, there are still challenges, such as inconsistent staff comprehension, mixed impacts on service delivery, resource allocation issues, and political meddling. Addressing these issues necessitates improved communication, continuous evaluation, and coordinated efforts to improve administrative systems and obtain consistent funding.

Understanding the Impact of Climate Change on Oral Health in Lower Middle-Income Countries.

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Assessing the knowledge and skill of vaccination staff at Adult Vaccination Counters for COVID-19 vaccines: Simulated client method.

The Government of Pakistan has established Adult Vaccination Counters (AVCs) to immunize general population with COVID-19 vaccine. Different brands of COVID-19 vaccines have different protocols. It is important that the knowledge and skills of the vaccination staff at AVCs should be accurate. To assess this, a cross-sectional study was conducted in all 15 AVCs at Khyber Pakhtunkhwa's provincial capital in May 2021, using the simulated client approach. Structured open-ended and simulated scenario-based questions were used to collect data from the vaccination staff of AVCs. This study showed that 53.3% of the AVCs had at most three out of four brands of COVID-19 vaccines. 60% of the AVCs did not have the mechanism to track client's vaccine first dose, date, and brand. Only 66.7% of the AVCs had a complete knowledge of all the available vaccines. 86.7% and 80% of the AVCs knew the correct duration and administration of the same brand of COVID-19 vaccine's second dose respectively. At the client's end, 6.7% were aware about the brand of administered COVID-19 vaccine. 46.7% were advised about the date of the second shot of vaccination. Only 13.3% of the clients were informed about the procedure of getting an official vaccination certificate. It was concluded that the knowledge and skill of the vaccination staff at AVCs is inadequate. Every vaccine has a different protocol in terms of number of doses and duration. AVCs must have a tracking system to inoculate the second dose with the same brand as the first dose. There is a need for rigorous monitoring and training of the COVID-19 vaccination staff on various protocols of vaccine to prevent losing public's trust.

Motivating employees through incentives: productive or a counterproductive strategy.

The disparity between human resource in health and provision of health services is a growing concern worldwide. Many developing countries are facing this crisis and therefore human resource in health is considered a high priority on their agenda.This imbalance between supplies of human resource is exacerbated by migration of health workers in many countries. Understanding the motivational factor is an important aspect to retain the migrating health workforce. This paper analyses the role of financial and non financial incentives in motivating the health work force. A review of available literature was conducted to understand the role of motivational factor in retaining health workforce. A review of current literature found that an incentive plays a key role in motivating a health worker. Financial incentives are useful in improving the compliance to standard policies and procedures. Comprehensive integrated incentive system approach should be established to develop a sustainable health workforce with required skill. Likewise monetary incentives should be linked to adherence to provincial and national guidelines and procedures. Sustainability could be ensured by commitment of government, political will and involvement of key stakeholders and decision makers.

SPHERE-based assessment of knowledge and preventive measures related to malaria among the displaced population of Jalozai, Pakistan.

OBJECTIVES: To assess the level of awareness regarding malaria, the availability of preventive material and its use in a camp for the internally displaced persons (IDPs) in Pakistan, using SPHERE standards and indicators. METHODS: The descriptive cross-sectional study was conducted in Jalozai from March to Novemeber 2010. Systematic random sampling was done with a sample size of 116 families (10% of Phase II). A structured questionnaire was distributed to the heads of the families and among healthcare providers. RESULTS: More than two-fifth (42%, n = 49) of the study population was unaware of malaria, while more than three-fifth (70%, n = 76) was ignorant of the preventive strategies. The study found that the surveyed population (55%, n = 64) had access to health education on diseases cased by mosquitoes but less than half of them (44%, n = 28) reported that health education included preventive strategies against malaria. Health education was done at community (40%) and household levels (60%). Simple Bed Nets were given to 68% (n = 78), while 26 (32%) families reported that the nets providers were not in a useable state. No education on the proper usage of bed nets was available, and replacement of the nets was not noticed. CONCLUSION: Health education programmes should include preventive methods. Provision of Insecticide Treated Nets (ITNs) to the displaced population, guidance by health awareness teams, and the replacement of old nets should be ensured to control malaria effectively.

Frequency and physical factors associated with gender-based violence in the internally displaced people of Pakistan.

Gender-based violence frequency and associated physical factors were determined in internally displaced people camp of Jalozai (Pakistan). Majority of families reported that security conditions were lacking and washrooms were neither illuminated (68%, n=29) nor locked (82%, n=31). Reported incidents of emotional violence were 56% (n=35), physical violence 42% (n=26) and sexual violence 18% (n=11). Health facilities reported 12 cases of gender-based violence/ month. No health education on prevention of gender-based violence (93%, n=56) neither psychologist was provided by any health facility. There was no refugee committee (95%, n=59) for women protection and health education (93%, n=56) for prevention of gender-based violence was done. To safeguard women and children proper lightening of passage, lock facilities in washrooms and timely reporting of gender-based violence cases should be ensured. This can be established by creating women protection committees and by conducting health education programs for gender-based violence.

Assessment of health services on relevant primary health care principles in internally displaced people of pakistan based on sphere standards and indicators.

SPHERE based assessment of internally displaced persons camp was done to assess health services on relevant primary health care principles using a cross-sectional survey in Jalozai Camp, Pakistan. Most of the households (74%, n=87) had access to health education addressing issues to protect and promote their health which was provided at household level (83%, n=72), community level (44%, n=38) and health centre level (13%, n=11). All the health facilities were culturally and socially acceptable in terms of language, separate waiting rooms, presence of female health providers and language translators. A referral system was in place which provided free transport in (67%, n=2) health facilities to tertiary care hospitals. Health services provided were culturally and socially acceptable and efforts on health education were also appreciable, except that no health education or intervention was done on HIV AIDS. Referral should be made to referral facilities within the districts instead of directly to tertiary care hospitals.

Bathing and cleaning practices in the camp of Jalozai Pakistan, for internally displaced people, based on Sphere Standards and Indicators.

OBJECTIVES: To evaluate the bathing and cleaning practice, based on Sphere Standards and Indicators, of internally displaced people in the camp of Jalozai, Pakistan. METHODS: This descriptive cross sectional survey was done in displaced population of Jalozai camp Nowshera from February to September 2010. Systematic Random Sampling was done (10% of Phase II Population). Study unit was a single family residing in the camp. A customized structured questionnaire was administered to households and information as recorded by the researchers. Informed consent and confidentiality was maintained while interviewing the household. RESULTS: Although 97% (n=111) families were using soap for bathing but surprisingly none of them were on required Sphere Standards. Similarly 93% (n=107) were using laundry soaps and 49% (n=56) were using washing powder but again were not fulfilling the standards. It was discovered based on our survey that 64% (n=71) displaced people were not using anything for cleaning their children and none were using washable nappies. It was also observed that 99% (n=114) were using toothpastes and other local means for dental hygiene. Less than 10 toothpastes/year were provided to 79% families while 21% (n=24) were not provided at all. CONCLUSION: Our survey population was not on required SPHERE standards for sufficient bathing and laundry soap and they had no access to sufficient amount of toothbrush and toothpaste. Children were not provided with washable nappies or diapers.