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HIV services for key populations (KP) at higher risk of HIV infection are often delivered by community-based organizations. To achieve HIV epidemic control, countries need to scale up HIV services for KP. Little is known about the management practices of community-based organizations delivering health services. We explored the management practices and facility characteristics of community-based health facilities providing HIV services to key populations as part of the LINKAGES program in Kenya and Malawi. We collected information on management practices from 45 facilities called drop-in centers (DICs) during US Government FY 2019, adapting the World Management Survey to the HIV community-based health service delivery context. We constructed management domain scores for each facility. We then analyzed the statistical correlations between management domains (performance monitoring, people management, financial management, and community engagement) and facility characteristics (e.g., number of staff, organization maturity, service scale) using ordinary least square models. The lowest mean management domain scores were found for people management in Kenya (38.3) and financial management in Malawi (25.7). The highest mean scores in both countries were for performance monitoring (80.9 in Kenya and 82.2 in Malawi). Within each management domain, there was significant variation across DICs, with the widest ranges in scores (0 to 100) observed for financial management and community involvement. The DIC characteristics we considered explained only a small proportion of the variation in management domain scores across DICs. Community-based health facilities providing HIV services to KP can achieve high levels of management in a context where they receive adequate levels of above-facility support and oversight-even if they deliver complex services, rely heavily on temporary workers and community volunteers, and face significant financial constraints. The variation in scores suggests that some facilities may require more above-facility support and oversight than others.
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OBJETIVO: Medir el acceso a través de la intermitencia en el suministro de agua potable en hogares mexicanos. Material y métodos. A través de la Encuesta Nacional de Salud y Nutrición 2022 (Ensanut 2022), se recolectó información sobre intermitencia en días por semana y horas por día durante las últimas cuatro semanas y el suministro de agua durante el año para la temporada de mayor escasez. RESULTADOS: 31.5% de los hogares recibieron agua los siete días de la semana, las 24 horas del día. De estos, 17.4% no tuvo escasez en los últimos 12 meses. La intermitencia es más común entre hogares de las regiones en el sur del país y entre los más pobres. El 81% de las familias almacena agua y 16% almacena en contenedores portátiles como cubetas. Conclusión. En este artículo se presentan por primera vez patrones de intermitencia en el suministro de agua a nivel nacional en México. La gran mayoría de las familias no reciben agua de forma continua y tienen que almacenar agua. El almacenamiento podría disminuir la calidad del agua y la falta de confianza para su consumo con consecuencias para la salud. La conexión al sistema potable no refleja el acceso real de las familias al agua.
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BACKGROUND: Identifying approaches to improve levels of health care provider knowledge in resource-poor settings is critical. We assessed level of provider knowledge for HIV testing and counseling (HTC), prevention of mother-to-child transmission (PMTCT), and voluntary medical male circumcision (VMMC). We also explored the association between HTC, PMTCT, and VMMC provider knowledge and provider and facility characteristics. METHODS: We used data collected in 2012 and 2013. Vignettes were administered to physicians, nurses, and counselors in facilities in Kenya (66), Rwanda (67), South Africa (57), and Zambia (58). The analytic sample consisted of providers of HTC (755), PMTCT (709), and VMMC (332). HTC, PMTCT, and VMMC provider knowledge scores were constructed using item response theory (IRT). We used GLM regressions to examine associations between provider knowledge and provider and facility characteristics focusing on average patient load, provider years in position, provider working in another facility, senior staff in facility, program age, proportion of intervention exclusive staff, person-days of training in facility, and management score. We estimated three models: Model 1 estimated standard errors without clustering, Model 2 estimated robust standard errors, and Model 3 estimated standard errors clustering by facility. RESULTS: The mean knowledge score was 36 for all three interventions. In Model 1, we found that provider knowledge scores were higher among providers in facilities with senior staff and among providers in facilities with higher proportions of intervention exclusive staff. We also found negative relationships between the outcome and provider years in position, average program age, provider working in another facility, person-days of training, and management score. In Model 3, only the coefficients for provider years in position, average program age, and management score remained statistically significant at conventional levels. CONCLUSIONS: HTC, PMTCT, and VMMC provider knowledge was low in Kenya, Rwanda, South Africa, and Zambia. Our study suggests that unobservable organizational factors may facilitate communication, learning, and knowledge. On the one hand, our study shows that the presence of senior staff and staff dedication may enable knowledge acquisition. On the other hand, our study provides a note of caution on the potential knowledge depreciation correlated with the time staff spend in a position and program age.
Assuntos
Circuncisão Masculina , Humanos , Transmissão Vertical de Doenças Infecciosas , Masculino , Adulto Jovem , ZâmbiaRESUMO
OBJECTIVE: To study changes in health care utilization in the public and private sector in Mexico in 2012 and 2018. MATERIALS AND METHODS: We used the 2012 and 2018-19 National Health and Nutrition Surveys and aggregated data on the supply of health services. RESULTS: There was an acceler-ated increase in medical offices in pharmacies (MOP) that was related to a lower use of public health services, even among the population with social security. We found that individu-als living in municipalities with a high density of MOP had a lower probability of using public services. The increase in the affiliation to the Seguro Popular (SP) was not followed by an increase in public health services and was not associated with a higher utilization of public health services. CONCLUSIONS: Affiliation or health insurance does not guarantee access to public services. Given the high increase in MOP, it is urgent to design and evaluate strategies to regulate their performance.
OBJETIVO: Estudiar los cambios en la utilización de servicios de salud públicos y privados en México entre 2012 y 2018. MATERIAL Y MÉTODOS: Usamos la Encuesta Nacional de Salud y Nutrición de los años 2012 y 2018 (Ensanut 2012 y Ensanut 2018-19), y datos agregados de la oferta de servicios de salud. RESULTADOS: Los consultorios adyacentes a farma-cias (CAF) crecieron aceleradamente y esto se relacionó con un menor uso de servicios públicos, aun en la población con seguridad social. Individuos que viven en municipios con alta densidad de CAF tienen menor probabilidad de usar servicios públicos. El aumento en la afiliación al Seguro Popular (SP) no se acompañó de un incremento de la oferta de servicios públicos y no se relaciona con mayor utilización de servicios públicos. CONCLUSIONES: Derechohabiencia y afiliación no garantizan el acceso a la atención médica en servicios públicos. Dada la creciente importancia de los CAF, es urgente diseñar y evaluar estrategias para regular su desempeño.
Assuntos
Atenção à Saúde , Serviços de Saúde , Farmácias , Acesso aos Serviços de Saúde , Humanos , Seguro Saúde , México , Farmácias/organização & administração , Saúde PúblicaRESUMO
Resumen: Objetivo: Estudiar los cambios en la utilización de servicios de salud públicos y privados en México entre 2012 y 2018. Material y métodos: Usamos la Encuesta Nacional de Salud y Nutrición de los años 2012 y 2018 (Ensanut 2012 y Ensanut 2018-19), y datos agregados de la oferta de servicios de salud. Resultados: Los consultorios adyacentes a farmacias (CAF) crecieron aceleradamente y esto se relacionó con un menor uso de servicios públicos, aun en la población con seguridad social. Individuos que viven en municipios con alta densidad de CAF tienen menor probabilidad de usar servicios públicos. El aumento en la afiliación al Seguro Popular (SP) no se acompañó de un incremento de la oferta de servicios públicos y no se relaciona con mayor utilización de servicios públicos. Conclusiones: Derechohabiencia y afiliación no garantizan el acceso a la atención médica en servicios públicos. Dada la creciente importancia de los CAF, es urgente diseñar y evaluar estrategias para regular su desempeño.
Abstract: Objective. To study changes in health care utilization in the public and private sector in Mexico in 2012 and 2018. Material and methods: We used the 2012 and 2018-19 National Health and Nutrition Surveys and aggregated data on the supply of health services. Results. There was an accelerated increase in medical offices in pharmacies (MOP) that was related to a lower use of public health services, even among the population with social security. We found that individuals living in municipalities with a high density of MOP had a lower probability of using public services. The increase in the affiliation to the Seguro Popular (SP) was not followed by an increase in public health services and was not associated with a higher utilization of public health services. Conclusions. Affiliation or health insurance does not guarantee access to public services. Given the high increase in MOP, it is urgent to design and evaluate strategies to regulate their performance.
